Recommendations for strain elastography of the uterine cervix.

PURPOSE: Conventional vaginal strain ultrasound elastography, not based on shear-wave elastography imaging, can assess the biomechanical properties of the uterine cervix. This assessment may inform the risks of preterm birth and failed induction of labor. However, there is considerable variation in the approaches to strain elastography, including the placement of the region of interest (ROI). Therefore, our aim was to provide recommendations for cervical elastography. METHODS: We conducted a literature review on (1) elastography principles, and (2) the cervical anatomy. Subsequently, we performed elastography scanning using a Voluson™ E10 Expert scanner with the BT18 software of (3) polyacrylamide hydrogel simulators, and (4) pregnant women. RESULTS: Increasing the distance between the ROI and probe led to a decrease in the obtained strain value; a 53% decrease was observed at 17.5 mm. Similarly, an increased angle between the ROI and probe-centerline resulted in a 59% decrease for 40° angle. Interposition of soft tissue (e.g., cervical canal) between the ROI and the probe induced an artifact with values from the posterior lip being 54% lower than those from the anterior lip, even after adjusting for probe-ROI distance. Equipment and the recording conductance significantly influenced the results. CONCLUSION: Our findings inform recommendations for future studies on strain cervical elastography.

Patient experience in prostaglandins-induced cervical ripening: A comparative study using a standardized questionnaire.

OBJECTIVE: Cervical ripening for induction of labor is often associated with negative patient experience. The debate over the most effective cervical ripening method persist, with a significant gap in research specifically addressing patient satisfaction. Our study aims to compare patient experience with two induction methods, slow-release intravaginal dinoprostone device and orally administered misoprostol. METHOD: We conducted a before-and-after comparative study at a university tertiary hospital, including all patients undergoing cervical ripening with a Bishop score of 3 or lower. Our study compared two separate two-month periods, where the methods for cervical ripening differed. The first period employed an intravaginal dinoprostone slow-release device, while the second period used oral misoprostol. The primary outcome was patient experience, assessed using the EXIT questionnaire, a standardized and validated self-reported measure. Secondary outcomes were efficacy and safety outcomes. RESULTS: A total of 165 patients were included, 81 induced with dinoprostone and 84 induced with misoprostol. The EXIT questionnaire completion rate was 67.9 % (n = 55) in the dinoprostone group and 76.1 % (n = 64) in the misoprostol group (p = 0.23). Patients induced with misoprostol reported higher levels of satisfaction compared to those induced with dinoprostone, which can be attributed to reduced discomfort associated with the induction process (mean satisfaction score 2.26 ± 0.98 versus 2.80 ± 0.85 on a 1 to 5 likert-scale, p-value < 0.01). Adverse effects were reported less frequently with misoprostol compared to dinoprostone (20.2 % vs 48.1 %, p-value < 0.01). Time between cervical ripening and delivery was shorter in the misoprostol group (27.0 ± 10.2 h vs 32.5 ± 10.0, p < 0.01). There were no difference in mode of delivery or other obstetrical and neonatal outcomes. CONCLUSION: For women undergoing cervical ripening, oral misoprostol appears to be a less invasive method for labor induction, associated with higher levels of satisfaction and reduced discomfort compared to the intravaginal dinoprostone slow-release device.

Outpatient cervical ripening with balloon catheters: A Bayesian network meta-analysis of randomized controlled trials.

BACKGROUND: One in four labors are induced. The process of cervical ripening can be lengthy and pre-labor hospitalization is required. Outpatient cervical ripening can be an attractive alternative. OBJECTIVES: To evaluate the efficacy and safety of outpatient cervical ripening with a balloon catheter compared with inpatient balloon catheter or prostaglandin E2 (PGE2). SEARCH STRATEGY: The PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library databases were searched from their inception to October 15, 2022. SELECTION CRITERIA: Randomized controlled trials comparing the outpatient balloon catheter with inpatient balloon catheter or inpatient PGE2 for term cervical ripening. DATA COLLECTION AND ANALYSIS: Bayesian network meta-analysis was performed. The primary outcome was the cesarean delivery rate. The secondary outcomes included instrumental delivery, the time from intervention-to-birth, oxytocin augmentation, total hospital duration, and maternal/neonatal adverse events. MAIN RESULTS: Twenty-nine randomized controlled trials with a total of 6004 participants were identified. No difference in the cesarean delivery rate was revealed among the three interventions. Compared with inpatient balloon catheter, outpatient balloon catheter had shorter total hospital duration (mean difference -8.58, 95% confidence interval -17.02 to -1.10). No differences were revealed in the time from intervention-to-birth, instrumental delivery, postpartum hemorrhage, 5-min Apgar score less than 7, umbilical cord arterial pH less than 7.1, and neonatal intensive care unit admission among the three interventions. CONCLUSIONS: Outpatient balloon catheter in low-risk term pregnancies is an available option that could be considered for cervical ripening. The safety and effectiveness are comparable to inpatient cervical ripening methods.

Klippel-Trenaunay syndrome and pregnancy: A Case-Report.

Klippel-Trenaunay Syndrome is a benign disease with a low incidence rate. Pregnant women with KTS may be at increased risk of thrombosis and coagulopathy due to normal hemodynamic changes during pregnancy. The choice of delivery route for KTS pregnant woman needs rigorous evaluation. This study reported a case of successful delivery by oxytocin combined with balloon catheter induction for the first time, providing more options for KTS pregnant woman. At the same time, this study reported a successful case of labor induced by oxytocin combined with balloon catheter for the first time, which further explored the obstetric management of pregnant women with KTS and provided them with more delivery options.

FIGO good practice recommendations for induced or spontaneous labor at term: Prep-for-Labor triage to minimize risks and maximize favorable outcomes.

The goal of induced or spontaneous labor is childbirth by vaginal delivery. Delivery after 37 weeks is desirable and associated with favorable maternal and newborn outcomes. Delivery facilities should have suitable staff and resources on site for antenatal services and delivery care. FIGO's Prep-for-Labor triage method provides rapid diagnostic tools that help define patients as high or low risk to determine whether transfer to a higher-level center is needed. There is often a disconnect between a facility's designation and its ability to achieve safe deliveries. For preplanned labor induction, the designated clinical facility must have the right set-up and prenatal records available to achieve a successful outcome. However, this is often not the case if a patient arrives in labor or needs an induction and the facility has limited patient information and resources, thus requiring rapid management decisions. The practical guidance checklist in this article defines maternal and/or fetal risk factors and delineates approaches and safe practices for labor induction and management, including when antenatal information is limited to maximize safe delivery practices. Guidelines on using the Bishop score (>6 or <6) to manage labor are presented. Evidence supporting successful safe labor induction at 41-42 weeks of gestation in low-risk cases is described. This practice will increase the rate of spontaneous labor and delivery, minimizing intervention and thereby diverting limited clinical resources to those patients in need. In the right setting, this could lead to around 80% of women delivering spontaneously, which remains a desired goal.

Predictors of vaginal delivery following balloon catheter for labor induction in women with one previous cesarean.

BACKGROUND: The aim of this study was to estimate predictors for vaginal birth following balloon catheter induction of labor (IOL) in women with one previous cesarean section (CS) and an unfavorable cervix. METHODS: This 4-year retrospective cohort study was conducted in Longhua District Central Hospital in Shenzhen China, between January 2015 and December 2018. Patients with one previous CS and a current singleton-term pregnancy who underwent balloon catheter cervical ripening and IOL were enrolled. Univariate analysis was used to identify predictive factors associated with vaginal birth after cesarean section (VBAC). Binary logistic regression was further used to identify which factors were independently associated with the outcome measure. The primary outcome was VBAC, which was a successful trial of labor after cesarean delivery (TOLAC) following IOL. RESULTS: A total of 69.57% (208/299) of the women who planned for IOL had VBAC. In the final binary logistic regression equation, lower fetal weight (< 4000 g) (odds ratio [OR]5.26; 95% confidence interval [CI] 2.09,13.27), lower body mass index (BMI,<30 kg/m2) (OR 2.27; CI 1.21, 4.26), Bishop score after cervical ripening > 6 (OR 1.94; CI 1.37, 2.76) remained independently associated with an increased chance of VBAC. CONCLUSIONS: The influencing factors of VBAC following IOL were fetal weight, BMI, and Bishop score after cervical ripening. Adequate individualized management and assessment of the IOL may help improve the VBAC rate.

Adverse neonatal outcomes and associated factors among mothers who gave birth through induced and spontaneous labor in public hospitals of Awi zone, Northwest Ethiopia: a comparative cross-sectional study.

BACKGROUND: Adverse neonatal outcomes are one of the most common causes of neonatal mortality and morbidity. Empirical evidence across the world shows that induction of labor potentiates adverse neonatal outcomes. In Ethiopia, there has been limited data that compares the frequency of adverse neonatal outcomes between induced and spontaneous labor. OBJECTIVES: To compare the prevalence of adverse neonatal outcomes between induced and spontaneous labor and to determine associated factors among women who gave birth in public hospitals of Awi Zone, Northwest Ethiopia. METHODS: A comparative cross-sectional study was conducted at Awi Zone public hospitals from May 1 to June 30, 2022. A simple random sampling technique was employed to select 788 (260 induced and 528 spontaneous) women. The collected data were analyzed using statistical package for social science (SPSS) software version 26. The Chi-square test and an independent t-test were used for categorical and continuous variables, respectively. A binary logistic regression was used to assess the association between the outcome and explanatory variables. In the bivariate analysis, a p-value ≤ 0.2 at a 95% confidence interval was used to consider the variables in the multivariate analysis. Finally, statistical significance was stated at a p-value of less than 0.05. RESULT: The adverse neonatal outcomes among women who gave birth through induced labor were 41.1%, whereas spontaneous labor was 10.3%. The odds of adverse neonatal outcomes in induced labor were nearly two times higher than in spontaneous labor (AOR = 1.89, 95% CI: 1.11-3.22). No education (AOR = 2.00, 95% CI: 1.56, 6.44), chronic disease (AOR = 3.99, 95% CI: 1.87, 8.52), male involvement (AOR = 2.23, 95% CI: 1.23, 4.06), preterm birth (AOR = 9.83, 95% CI: 8.74, 76.37), operative delivery (AOR = 8.60, 95% CI: 4.63, 15.90), cesarean section (AOR = 4.17, 95% CI: 1.94, 8.95), and labor complications (AOR = 5.16, 95% CI: 2.90, 9.18) were significantly associated factors with adverse neonatal outcomes. CONCLUSION AND RECOMMENDATION: Adverse neonatal outcomes in the study area were higher. Composite adverse neonatal outcomes were significantly higher in induced labor compared to spontaneous labor. Therefore, it is important to anticipate the possible adverse neonatal outcomes and plan management strategies while conducting every labor induction.

The REDUCED trial: a cluster randomized trial for REDucing the utilization of CEsarean delivery for dystocia.

BACKGROUND: To reduce cesarean delivery rates in nulliparous women, guidelines for diagnosing nonprogressive labor have been developed by the National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. These are mainly based on data from the Consortium for Safe Labor study. The guidelines have not been tested in a clinical trial, so the efficacy and safety of this new approach is uncertain. OBJECTIVE: This study aimed to assess whether adoption of new guidelines for diagnosing nonprogressing labor would reduce cesarean delivery rates. STUDY DESIGN: We conducted a cluster randomized controlled trial of a knowledge translation program of the guidelines in 26 Canadian hospitals (13 control sites and 13 intervention sites). The sites included all intrapartum care sites in Alberta that perform cesarean delivery and deliver at least 70 nulliparous women annually. The baseline period started on January 1, 2015. The intervention was initiated at the first intervention site in January 2017. The follow-up period began at the first intervention site in February 2017 and lasted till February 2020. The primary outcome was the rate of cesarean delivery in nulliparous women with vertex presentation in labor at term. The secondary outcomes included spontaneous vaginal birth and maternal and neonatal safety. The main data source for the primary and secondary outcomes was the Alberta Perinatal Health Program database. The cesarean delivery rates were assessed using repeated measures mixed effects logistic regression applied to individual births. RESULTS: The analysis was based on 45,193 deliveries at intervention sites and 43,725 deliveries at control sites. There was no evidence of a decrease in the rate of cesarean delivery in association with the intervention (baseline-adjusted odds ratio, 0.94; 95% confidence interval [0.85-1.05]; P=.259). The rate of spontaneous vaginal delivery increased slightly (baseline-adjusted odds ratio, 1.10; 95% confidence interval, [1.01-1.18]; P=.024). We did not observe any differences in adverse maternal or neonatal outcomes. CONCLUSION: Cesarean delivery rates in nulliparous women were not reduced by the application of recent guidelines for the diagnosis of nonprogressive labor. Spontaneous vaginal delivery-a secondary outcome-was increased in the intervention group. The intervention appears to be safe.

Effects of the Oxytocin Hormone on Pelvic Floor Muscles in Pregnant Rats.

Background and Objectives: Oxytocin induction is a known risk factor for pelvic floor disorders (PFDs). The aim of the study was to investigate the effects of oxytocin induction on pelvic floor muscles in pregnant rats. Methods: Thirty-two female Wistar rats were included and divided into four groups (n = 8). The groups were as follows: virgin group (group I)-from which muscles were dissected at the beginning of the experiment; spontaneous vaginal delivery (group II) which has delivery spontaneously; saline control group (group III) and oxytocin group (group IV). In groups III and IV, pregnancy was induced on d 21 of pregnancy, with 2.5 mU saline solution or iv oxytocin, respectively, delivered by the intravenous (iv) route in pulses at 10-min intervals for 8 h. Then, the rats were euthanized, the m. coccygeus, m. iliocaudalis and m. pubocaudalis muscles were excised and tissue samples were taken. After histological processing, the vertical and horizontal dimensions of the muscles were analyzed under a light microscope. Results: In group IV; the measurement of the horizontal dimension of the m. pubocaudalis muscles was 50.1 ± 5.4 µm and it was significantly higher than other groups (p < 0.001). In group III; the mean value of the horizontal dimension of m. coccygeus muscle was found to be 49.5 ± 10.9 µm and it was significantly higher than other groups (p < 0.009). Between-group comparisons revealed no difference in mean m. iliocaudalis muscle dimension (p > 0.05). Conclusions: As a result of our study it can say that whether oxytocin induced or not, vaginal birth is a process that affects the pelvic muscles.

Foley catheter plus misoprostol versus misoprostol alone for labor induction

SUMMARY OBJECTIVE: This study aimed to analyze the effects of Foley catheter combined with misoprostol in the labor induction process. METHODS: This is a nonblinded, block randomized, controlled trial that compared the association between transcervical Foley catheter/vaginal misoprostol 25 μg combination and vaginal misoprostol 25 μg alone in normal-risk and healthy pregnant women undergoing labor induction in the south of Brazil. RESULTS: A total of 230 patients with indications for labor induction were evaluated and classified into the "combined" group (Foley catheter plus misoprostol), consisting of 107 patients, and the "misoprostol" group (misoprostol only), consisting of 123 patients. The "combined" group was observed to have a shorter labor induction time (p=0.008). In addition, there was a lower need for misoprostol use for overall cervical ripening (p<0.001) and a lower relative risk of needing a second, third, or fourth misoprostol tablet in the "combined" group (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.71-0.91; RR 0.41; 95%CI 0.31-0.56; and RR 0.29, 95%CI 0.17-0.52, respectively) (p<0.001). No statistically significant difference was found in induction failure rate, cesarean section rate, or perinatal outcomes. CONCLUSION: A combination of methods leads to shorter labor induction, lower need for misoprostol doses, and lower risk of cesarean section, with no increase in the rate of perinatal complications. REBEC number is RBR-7xcjz3z.

Acute Gallstone Pancreatitis in Pregnancy: A Multidisciplinary Approach.

A common cause of gastrointestinal-related hospitalizations in the United States of America is acute pancreatitis (AP), with an annual incidence of up to 80 cases per 100,000 people. The incidence of AP in pregnancy varies and is approximately 1 in 1000 to 1 in 10,000 births due to the prevalence of obesity and gallstone-related conditions. Deciding on the timing of surgical intervention in acute biliary pancreatitis during pregnancy remains challenging, and there are no consensus recommendations. Gallstone pancreatitis has a high recurrence rate of up to 50% during the first trimester. A 30-year-old G3P2 at 34 weeks of gestation presented to the emergency room (ER) with recurrent intermittent sudden severe epigastric and right upper quadrant abdominal pain radiating to the back. She had no history of alcohol consumption, and lipid studies were normal on presentation. A right upper quadrant ultrasound scan showed cholelithiasis without signs of acute cholecystitis and a common bile duct diameter of 0.5 cm. However, her serum lipase level was 824, compared to normal levels on her previous ER visits. Other significant labs included elevated alkaline phosphatase (ALP) of 125 and mild transaminitis, with alanine transaminase (ALT) and aspartate aminotransferase (AST) levels of 84 and 57, respectively. She was admitted on account of suspected gallstone pancreatitis and was treated supportively with IV fluids and adequate pain control with opioids. A subsequent magnetic resonance cholangiopancreatography (MRCP) revealed no obvious choledocholithiasis. After consultation with the obstetrics, gastroenterology, and general surgery teams, it was decided to defer cholecystectomy until after delivery. The patient was induced at 36 weeks of gestation, and she had an uneventful vaginal delivery. Two weeks later, she had an elective laparoscopic cholecystectomy with no complications.

Maternal and neonatal morbidities associated with cesarean delivery without labor compared with induction of labor around term.

OBJECTIVE: We aimed to compare the maternal and neonatal morbidities associated with elective cesarean delivery (CD) without labor and those associated with induction of labor (IOL) at ≥38 weeks of gestation. METHODS: This retrospective observational study from 2013 to 2020 included singleton pregnancies in nulliparous women at ≥38 weeks of gestation. Maternal and neonatal morbidities associated with elective CD without labor were compared with those associated with IOL. RESULTS: Altogether, 395 women were recruited. Among these, 326 underwent delivery through IOL, while 69 underwent elective CD. The elective CD group exhibited higher maternal age, lower gestational age at birth, and lower neonatal birth weight than the IOL group (P<0.001). Moreover, the elective CD group exhibited longer hospital stay, higher rate of uterotonic agent usage, and lower rate of antibiotic usage after discharge. However, no differences were observed in postpartum bleeding, readmission, or number of outpatient visits (>3) after discharge between the groups. Perinatal morbidities were similar between the groups except the incidence of meconium-stained amniotic fluid. Elective CD exhibited similar rates of complications related to composite maternal morbidity when compared with IOL, but had a lower risk of complications related to composite neonatal morbidity (relative risk, 0.45; 95% confidence interval, 0.24-0.85). CONCLUSION: Elective CD and IOL had similar rates of composite maternal morbidity but the former exhibited some benefits against obstetric wound infection. The elective CD group exhibited a decreased risk of composite neonatal morbidity despite lower gestational age at birth and higher maternal age.

Magnitude of episiotomy practice and associated factors among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

Background: Episiotomy is an intentional surgical incision made on the perineum with the aim of enlarging the introits during the second stage of labor or just before delivery of the baby. It sometimes also interferes with the mother's comfort during the postpartum period and has associated complications especially when it is done without indication. However, there is limited information regarding episiotomy practice in the study area. Objective: This study aimed to determine the magnitude of episiotomy practice and associated factors among women who gave birth at the Hiwot Fana Specialized University Hospital, Eastern Ethiopia, 2021. Methods: A facility-based cross-sectional study was conducted among 408 systematically selected mothers who gave birth at the Hiwot Fana Specialized University Hospital, from 1 January to 30 December 2021. Datas were collected from delivery medical records using a pretested checklist. The extracted data were checked, coded, and entered into the Epi-data version 3.1 and exported to the STATA version 16 software for analysis. Binary logistic regression was fitted to identify factors associated with episiotomy practice. P-values < 0.05 were considered to declare the presence of statistical significance. Results: The overall prevalence of episiotomy practice was found to be 43.4 % (95% CI: 38.7, 48.9), and mediolateral was the most commonly practiced episiotomy type (41.4%). Parity [AOR: 6.2; 95% CI (3.8-17.6)], 1st min Apgar score [AOR: 1.6; 95% CI (1.04-2.67)], presence of maternal medical disease [AOR: 3.3; 95% CI (1.09-6.9)], and induced labor [AOR: 1.6; 95%CI (1.12, 4.13)] were significantly associated with the episiotomy practice. Conclusion: The prevalence of episiotomy practice in the study area was high. Parity, presence of maternal medical disease, induction of labor, and 1st min APGAR score were significant factors associated with episiotomy practice. Considering the presence of appropriate indications or preventing unjustifiable indications, can help to reduce the current high practice rates.

The Impact of Mouse Preterm Birth Induction by RU-486 on Microglial Activation and Subsequent Hypomyelination.

Preterm birth (PTB) represents 15 million births every year worldwide and is frequently associated with maternal/fetal infections and inflammation, inducing neuroinflammation. This neuroinflammation is mediated by microglial cells, which are brain-resident macrophages that release cytotoxic molecules that block oligodendrocyte differentiation, leading to hypomyelination. Some preterm survivors can face lifetime motor and/or cognitive disabilities linked to periventricular white matter injuries (PWMIs). There is currently no recommendation concerning the mode of delivery in the case of PTB and its impact on brain development. Many animal models of induced-PTB based on LPS injections exist, but with a low survival rate. There is a lack of information regarding clinically used pharmacological substances to induce PTB and their consequences on brain development. Mifepristone (RU-486) is a drug used clinically to induce preterm labor. This study aims to elaborate and characterize a new model of induced-PTB and PWMIs by the gestational injection of RU-486 and the perinatal injection of pups with IL-1beta. A RU-486 single subcutaneous (s.c.) injection at embryonic day (E)18.5 induced PTB at E19.5 in pregnant OF1 mice. All pups were born alive and were adopted directly after birth. IL-1beta was injected intraperitoneally from postnatal day (P)1 to P5. Animals exposed to both RU-486 and IL-1beta demonstrated microglial reactivity and subsequent PWMIs. In conclusion, the s.c. administration of RU-486 induced labor within 24 h with a high survival rate for pups. In the context of perinatal inflammation, RU-486 labor induction significantly decreases microglial reactivity in vivo but did not prevent subsequent PWMIs.

Analysis of Variables that Influence the Success Rates of Induction of Labor with Misoprostol: A Retrospective Observational Study / Análise de variáveis que influenciam na taxa de sucesso da indução do parto com misoprostol: Um estudo observacional retrospectivo

Abstract Objective Determine the predictive criteria for success in inducing labor for live fetuses using misoprostol in pregnant women. Secondarily, the objective is to determine the rates of vaginal or cesarean delivery, duration of induction, interval of administration of misoprostol, the main causes of induction of labor and indication for operative delivery. Methods Medical records of 873 pregnant women admitted for cervical maturation from January 2017 to December 2018 were reviewed in a descriptive observational study of retrospective analysis, considering the following response variables: age, parity, Bishop Index, doses of misoprostol, labor induction time. Logistic regression models were used to predict success with misoprostol in non-operative deliveries. Results Of the 873 patients evaluated, 72% evolved with vaginal delivery, 23% of the cases were cesarean, 5% forceps or vacuum-extractor. For non-operative delivery the predictive variables at admission were age, parity, gestational age and dilation. During hospitalization, fewer vaginal touches,amniotomy or amniorrhexis with clear fluid lead to a shorter induction time and a greater chance of non-operative delivery. False positives and false negatives of the model were always below 50% and correct answers above 65%. Conclusion At admission, age less than 24 years, previous normal births, lower the gestational age and greater the dilation, were predictive of greater probability of nonoperative delivery. During hospitalization, the less vaginal touches and occurrence of amniotomy/amniorrhexis with clear liquid indicate shorter induction time. Future studies with a prospective design and analysis of other factors are necessary to assess the replicability, generalization of these findings.

Resumo Objetivo Determinar os critérios preditivos para o sucesso na indução do trabalho de parto para fetos vivos utilizando misoprostol em gestantes. Em segundo lugar, o objetivo é determinar as taxas de parto vaginal ou cesáreo, duração da indução, intervalo de administração de misoprostol, as principais causas de indução do trabalho de parto e indicação para parto operatório. Métodos Foram revisados os prontuários de 873 gestantes internadas para amadurecimento cervical entre janeiro de 2017 e dezembro de 2018 em um estudo descritivo observacional de análise retrospectiva, considerando as variáveis-resposta: idade, paridade, Índice de Bishop, doses de misoprostol, tempo de indução do trabalho de parto. Modelos de regressão logística foram utilizados para prever o sucesso com misoprostol em partos não operatórios. Resultados Dos 873 pacientes avaliados, 72% evoluíram com parto vaginal, 23% dos casos foram cesáreos, 5% fórceps ou vácuo-extrator. Para o parto não operatório as variáveis preditivas na internação foram idade, paridade, idade gestacional e dilatação. Durante a internação, um menor número de toques vaginais, amniotomia ou amniorrexe com líquido claro, levam a menor tempo de indução e maior chance de parto não operatório. Falsos positivos e falsos negativos do modelo sempre foram inferiores a 50% e respostas corretas acima de 65%. Conclusão Na internação, idade menor que 24 anos, ocorrência de partos normais anteriores, menor idade gestacional e maior dilatação, foram preditivos de maior probabilidade de parto não-operatório. Durante a internação, o menor número de toques vaginais, amniotomia/amniorrexe com líquido claro indicam menor tempo de indução. Estudos futuros com design prospectivo e análise de outros fatores são necessários para avaliar a replicabilidade, generalização desses achados.

Online health information on induction of labour: A systematic review and quality assessment study.

OBJECTIVES: Many women will seek information online about induction of labour. However, the quality of the available information varies greatly and there are no regulations regarding the content that is published. Our objective was to systematically evaluate the quality of online health information on induction of labour. STUDY DESIGN: We established a bespoke search strategy with our public and patient representative using common induction of labour search terms. In January 2021 we used the metasearch engines Dogpile, Duckduckgo and Ecosia to identify relevant websites and additional searches were undertaken using different google platforms. We included all open access websites in English which provided specific advice to women on induction of labour. We assessed the quality of the websites for their credibility, accuracy, readability, and content quality in duplicate. The websites were compared according to their source of funding, target user and whether they were pregnancy specific websites or generic. There was no funding for this project. RESULTS: We screened 2875 websites from the searches. 221 websites were included out of which only 45 (20%) were pregnancy specific and 109 (50%) had governmental funding. Generic websites had higher credibility (median 6.0 vs 5.5; p = 0.031), accuracy (median 10.75 vs 9.5; p = 0.042) and quality scores (median 45.0 vs 40.0; p = 0.036) than pregnancy specific ones. Those with governmental funding had higher quality scores than commercially funded ones for credibility (median 6.5 vs 5.5; p = 0.002), accuracy (median 13.5 vs 9.0; p < 0.000), readability (72.2 vs 61.2; p = 0.001) and quality (51.0 vs 38.5; p=<0.000). CONCLUSIONS: The quality of online health information on induction of labour is varied. Governmental websites seem to offer better quality information to pregnant women awaiting induction of labour.

Maternal and Neonatal Outcomes of Elective Induction of Labor at 39 or More Weeks: A Prospective, Observational Study.

The purpose of our study is to compare the maternal and neonatal outcomes of induction of labor (IOL) versus expectant management at 39 weeks of gestation. We conducted a single-centered, prospective, observational study of nulliparous singleton women at 39 weeks or more. We compared the maternal and perinatal outcomes. Of 408 nulliparous women, 132 women were IOL group and 276 women were expectant management group. IOL and expectant group had similar cesarean delivery rate (18.2% vs. 15.9%, p = 0.570). The delivery time from admission was longer in IOL group (834 ± 527 vs. 717 ± 469 min, p = 0.040). The IOL group was less likely to have Apgar score at 5 min < 7 than in expectant group (0.8% vs. 5.4%, p = 0.023). Multivariate analysis showed that IOL at 39 weeks was not an independent risk factor for cesarean delivery (relative risk 0.64, 95% confidence interval: 0.28−1.45, p = 0.280). Maternal and neonatal adverse outcomes, including cesarean delivery rate, were similar to women in IOL at 39 weeks of gestation compared to expectant management in nulliparous women. IOL at 39 weeks of gestation could be recommended even when the indication of IOL is not definite.

Spontaneous and induced labor: association with maternal well-being three months after childbirth.

A woman's first childbirth represents a moment of elevated maternal emotional vulnerability. Indeed, there is a prevalence of anxiety and depression symptomatology in primiparas during the postpartum period that negatively influences the well-being of the woman, of her newborn, and of the quality of their attachment bond. Much attention has been paid to the possible risk factors involved in the onset of mood disturbance in the postpartum. However, knowledge is still limited regarding the role played by the specific clinical aspects linked to labor. Therefore, the aim of the present study was to explore whether spontaneous or elective induction labor is linked to the level of postnatal depression and anxiety three months after birth. One hundred and sixty-one women (Mage = 31.63; SD = 4.88) were recruited, using the following inclusion criteria: native Italian women; age > 18 years; physically and psychologically healthy nulliparous with singleton no-risk pregnancy; no previous abortion or interruption of pregnancy; no previous psychopathological diagnoses. Exclusion criteria: twin pregnancy, fetal pathologies, and planned elective cesarean. Data was collected at two different times: T1 (day of childbirth) clinical data of labor (spontaneous or induced) from hospital records; T2 (three months after birth) level of mother's depression and anxiety. In order to explore if the level of depression and anxiety three months after childbirth differ in women according to the type of labor, spontaneous or induced, two univariate analyses of variance (ANOVA) were conducted. Results showed that women who had a spontaneous labor reported lower levels of anxiety and depression than women who had an induced labor. Our results highlight the significant implications that the mode of labor has on the emotional well-being of mothers, underlining the need to support women throughout all their transition to motherhood, including the childbirth experience.

Impact of the Induction of Labor on Hemophilia Carriers and Their Newborn Infants.

Hemophilia is a risk for severe hemorrhage in newborns during the perinatal period and excessive postpartum hemorrhage (PPH) in hemophilia carriers. Vacuum extraction or use of forceps should be avoided to prevent neonatal intracranial hemorrhage (ICH). Optimal modes of delivery such as vaginal or cesarean section are open to debate. The safety of the induction of labor is also worthy of investigation. Here we ask if labor induction is a safe delivery mode for pregnant women who are hemophilia carriers and their infants. We looked at 13 deliveries by hemophilia carriers at our hospital from 2005 to 2018. Two of the five male neonates complicated by hemophilia suffered ICH complications (40%). Both were delivered by induced labor. No deliveries by carriers had PPH which required treatment. Our data indicate that the induction of labor may provoke ICH in infants with hemophilia. We suggest that induction of labor is not a preferable delivery method for hemophilia carriers to avoid neonatal ICH.

Estado ponderal pregestacional, ganancia de peso y resultados obstétricos en embarazadas atendidas en el Hospital de la Mujer de Sevilla / Prepregnancy weight status, weight gain, and obstetrical outcomes in pregnant women managed at the Hospital de la Mujer in Seville

Objetivo: describir las características del estado y control ponderal de las mujeres embarazadas atendidas en el Hospital de la Mujer de Sevilla y evaluar la asociación de estos factores con los resultados obstétricos en este contexto.Material y método: se realizó un estudio descriptivo transversal. Se incluyó a mujeres adultas, con seguimiento desde el primer trimestre y parto a término que dieron a luz entre septiembre de 2017 y febrero de 2018. Se excluyó a las no hispanohablantes, sin datos de peso iniciales, embarazos gemelares, diabetes o hipertensión arterial pregestacional. Se recogieron datos del Documento de Salud de la Embarazada: variables independientes (edad, nivel de estudios, nacionalidad, IMC pregestacional, adecuación de la ganancia de peso gestacional a las recomendaciones, paridad) y dependientes (comienzo de parto, motivo de inducción y tipo de parto). Se realizaron análisis descriptivos y bivariantes.Resultados: participaron 221 mujeres [edad media 30,7 (DE 5,5)]. El índice de masa corporal (IMC) pregestacional superó el límite normal en el 44,8% y la ganancia de peso durante el embarazo fue mayor a la recomendada en el 29,9%. El IMC pregestacional óptimo y la adherencia a las recomendaciones de ganancia de peso se asociaron con mayor proporción de inicio de parto espontáneo (p= 0,022 y p= 0,029, respectivamente). No se encontró esta relación con el tipo de parto (p> 0,05), pero se aproximó a la significación con mayor proporción de cesáreas cuando se excedió la recomendación.Conclusión: los resultados sugieren la importancia del papel de la matrona en mujeres con sobrepeso u obesidad que deseen gestar y en la educación para una adecuada ganancia de peso durante la gestación.(AU)

Objective: to describe the characteristics of weight status and control in pregnant women managed at the Hospital de la Mujer in Seville, and evaluate the association between these factors and the obstetrical outcomes in this setting.Materials and method: a cross-sectional descriptive study was conducted, including adult women, with follow-up since the first trimester and delivery at term, who gave birth between September, 2017 and February, 2018. Non-Spanish-speaking women were excluded, as well as those without initial weight data, twin pregnancies, or prepregnancy diabetes or hypertension. Data were collected from the Pregnancy Medical Record: independent variables (age, education level, nationality, prepregnancy BMI, whether gestational weight gain was adequate according to recommendations, parity) and dependent variables (onset of labor, reason for induction, and type of delivery). Descriptive and bivariate analyses were conducted.Results: the study included 221 women [mean age: 30.7 (SD 5.5)]. The prepregnancy body mass index (BMI) exceeded the normal level in 44.8% and the weight gain during pregnancy was higher than recommended in 29.9%. An optimal pregestational BMI and adherence to weight gain recommendations were associated with a higher rate of spontaneous onset of labor (p= 0.022 and p= 0.029, respectively). This association was not found with type of delivery (p> 0.05), but it was close to significant values with Caesarean deliveries when the recommendation was exceeded.Conclusion: these outcomes point at the importance of the midwife role for overweight or obese women who want to have children, and education for an adequate weight gain during pregnancy.(AU)