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OBJECTIVE: to study the true determinants of adverse perinatal outcome (APO) in term healthy mothers with normal cardiotocograph (CTG), evaluating the real influence of maternal age. MATERIAL AND METHODS: In a retrospective study, we assessed a group of 529 term healthy mothers with normal CTGs that regardless of maternal age, evolved spontaneously up to 41 ± 2 weeks. The result of the conservative management was evaluated by means of univariable and multivariable logistic regression analysis, determining the association of maternal age and other clinical and ultrasonographical parameters with APO. RESULT: In contrast with low CPR MoM (OR = 0.155, p = .014), induction of labor (OR = 2.273, p = .023) and low parity (OR = 0.494, p = .026), maternal age and birth weight centile did not prove to be true determinants of perinatal outcome. The multivariable model for prediction of APO using clinical parameters presented a sensitivity of 35% and 27% for a false positive rate of 10% and 5%, AUC 0.736 (95% CI 0.655-0.818), p < .0001). CONCLUSIONS: in healthy old mothers with normal CTGs at term, APO is determined by low CPR, the existence of labor induction and low parity, while no real influence was observed for maternal age, fetal smallness, and interval examination-delivery. These results do not support the current consensus on induction at earlier weeks to prevent adverse outcomes in all cases of advanced maternal age, advocating for a more individualized, customized, and less interventional management based on fetal hemodynamics.

Objective. The aim of this study was to compare intracervical (IC) and intravaginal (IV) application of prostaglandin E2 (PGE2) for labor induction in term pregnancies with unfavorable cervix. Study design. This prospective randomized trial included 212 pregnant women with term pregnancy and unfavorable cervix randomly assigned for labor induction with either IC (0.5mg) or IV (2mg) PGE2 formulation. Main outcome measured was time interval from labor induction to delivery. Difference in mode of delivery and adverse perinatal outcomes between two studied groups was also investigated. Significance was set at p < 0.05. Results. Studied groups did not significantly differ regarding main characteristics such as age, parity, body mass index or Bishop score. Women in IV group compared to those in IC group had shorter induction to delivery time interval (p

OBJECTIVE To assess the cost-effectiveness of vaginal misoprostol (PGE1; 25 μg) compared with a slow-release dinoprostone (PGE2) pessary (10 μg) for labor induction due to an unfavorable cervix at term. METHODS We used data from an open-label multicenter, randomized non-inferiority trial that recruited women for whom labor was induced for medical reasons. The incremental cost-effectiveness ratio was assessed from the payer's perspective, with the focus on inpatient care costs and using the cesarean deliveries avoided (CDA) rate as the primary analysis and the rate of vaginal delivery within 24 h (VD24) as the secondary analysis. RESULTS Analyses were based on 790 women in each group. Differences between treatment arms were the mean cost per patient of €4410 and €4399, a CDA rate of 80.1% and 77.9% and a VD24 rate of 46.1% and 59.4% for dinoprostone and misoprostol, respectively. Dinoprostone is not cost-effective according to the CDA rate and misoprostol was either a cost-effective or a dominant strategy according to the VD24. CONCLUSION Misoprostol and dinoprostone have equal cost management with mixed efficacy according to the clinical outcome used. Finally, misoprostol may be an attractive option for hospitals as the price is lower and it is easier to use. TRIAL REGISTRATION ClinicalTrials.gov: NCT01765881. URL: https://clinicaltrials.gov/ct2/show/NCT01765881. ClinicalTrialRegistrer.eu: 2011-000933-35. URL: https://www.clinicaltrialsregister.eu/ctr-search/trial/2011-000933-35/FR.

OBJECTIVE To examine the simultaneous effect of high-volume Foley catheter (HVFC) (60 ml) and vaginal misoprostol on labor induction in nulliparous women. METHODS A randomized, double-blind, controlled trial was conducted among nulliparous post-date (>40 weeks) pregnant women between June and December 2019. At enrollment 100 women were randomized into each group (either HVFC and vaginal misoprostol or low-volume Foley catheter [LVFC] [30 ml] and vaginal misoprostol), for labor induction. Demographic and clinical data were collected at enrollment and delivery. RESULTS Women in the HVFC group had statistically significantly shorter induction to delivery interval (median 860 min, interquartile range [IQR] 840-940 min vs. 1160 min, IQR 1080-1320 min, P

Background This study aimed to analyze perinatal outcomes and adverse events during the COVID‐19 pandemic's first wave to help direct decision making in future waves. Methods This study was an epidemiological cohort study analyzing comprehensive birth registry data among all 80 obstetric departments in Austria. Out of 469 771 records, 468 348 were considered eligible, whereof those with preterm delivery, birthweight

To compare perinatal outcomes following induction of labor in dichorionic versus monochorionic twin pregnancies. A retrospective cohort study analyzing all women with twin pregnancies who underwent induction of labor in a single university-affiliated tertiary medical center. The cohort included 290 women who were divided into 2 groups according to chorionicity: (1) dichorionic twin pregnancies (n = 203); (2) monochorionic twin pregnancies (n = 87). Induction of labor methods included oxytocin infusion, extra-amniotic balloon catheter and artificial amniotomy. Primary outcome was defined as mode of delivery. Secondary outcomes included maternal and neonatal adverse events. Primary outcome did not differ between groups, with vaginal delivery rate of 92.1% in the dichorionic group and 94.2% in the monochorionic group. Women with dichorionic twins delivered later compared to monochorionic twins (38.00 weeks vs. 36.43 weeks, respectively, p

Background: There is evidence of destructive effects of oxytocin use during labor on neurodevelopment. Purpose: This meta-analysis pooled all observational studies to determine the association between labor induction and the risk of attention-deficit/hyperactivity disorder (ADHD) among children.Methods: All observational studies (case-control and cohort) were reviewed until September 2020 after searches of the PubMed, Scopus, and Web of Science databases, the gray literature, and conference proceedings. The pooled odds ratios (ORs), relative ratios (RRs), and 95% confidence intervals (CI (swere calculated as random effect estimates of association among studies.Results: All observational studies were reviewed, including 4 cohort studies including 2,885,743 participants and 3 casecontrol studies including 51,135 participants (10,961 with ADHD and 40,174 in control groups) with a sample size of 2,936,878 participants. The pooled estimates of OR and RR did not indicate a significant association between labor induction and ADHD among children (OR, 1.13; 95% CI, 0.90–1.35) and (RR, 1.10; 95% CI, 0.96–1.24).Conclusions: The findings showed that labor induction is not associated with an increased risk of ADHD among children. However, more studies are needed to investigate the relationship between labor induction and ADHD.

To estimate the risk of shoulder dystocia (SD) in pregnancies with/without maternal diabetes or obesity; to identify antenatal maternal and fetal ultrasound-derived risk factors and calculate their contributions. A multicenter retrospective analysis of 13,428 deliveries in three tertiary hospitals (2014–2017) with fetal ultrasound data ≤ 14 days prior to delivery (n = 7396). Inclusion criteria: singleton pregnancies in women ≥ 18 years old; vertex presentation; vaginal delivery at ≥ 37 weeks of gestation. Estimated fetal weight (EFW) and birth weight (BW) were categorized by steps of 250 g. To evaluate risk factors, a model was performed using ultrasound data with SD as the dependent variable. Diabetes was present in 9.3%; BMI ≥ 30 kg/m2 in 10.4% and excessive weight gain in 39.8%. The total SD rate was 0.9%, with diabetes 2.0% and with obesity 1.9%. These increased with BW 4250–4499 g compared to 4000–4249 g in women with diabetes (12.1% vs 1.9%, P = 0.010) and without (6.1% vs 1.6%, P

OBJECTIVE: Dinoprostone is a drug of choice in our daily practice for the induction of labor. The aim of our study; to compare the use of oxytocin with dinoprostone (PGE2- Propess©) used in term multiparous pregnant women to ripen the cervix.STUDY DESIGN: A total of 507 patients were included in the study. Group A, consisted of 262 women with term multiparous pregnancy Bishop score ≤6 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (Propess© -prostaglandin E2). Group B, consisted of 245 cases of pregnancy with Bishop score ≤6 underwent induction of labor with iv oxytocin and was matched for the patient's age and parity. The following data were recorded: age, gestational age, body mass index, the time from the drug administration to the vaginal labor, delivery mode, indications of induction, cesarean indication, birth weight, Apgar score, and need of neonatal intensive care unit. RESULTS: The primary outcome of the in group B interval from induction to vaginal delivery was similar between the two groups. In group A, 41 patients and in group B, 23 patients had a cesarean section. Cesarean section rate was lower in the oxytocin group (cesarean rate 15.6% versus 9.3%, p

Background: It was hypothesized that the oxytocin used during labor could increase the risk of neurodevelopmental disorders, such as ASD. Objective: This meta-analysis pooled all observational studies to obtain the association between labor induction and the risk of ASD among children. We identified all published studies up to August 2020 by search in PubMed, Scopus, Web of Science and gray literature. The pooled odds ratios (OR), relative ratio (RR) and 95% confidence intervals (CI (were calculated as random effect estimates of association among studies. : We identified all published studies up to August 2020 by search in PubMed, Scopus, Web of Science and gray literature. The pooled odds ratios (OR), relative ratio (RR) and 95% confidence intervals (CI (were calculated as random effect estimates of association among studies. Results: The pooled estimates of OR and RR reported a significant association between labor induction and ASD among children, respectively (OR = 1.09, 95% CI = 1.04 to 1.15) and (RR = 1.06, 95% CI = 1.02 to 1.09). The subgroup analyses were performed based on the adjusted form and design of studies. OR in crude and adjusted studies were reported to be 1.25(1.01, 1.49) and 1.08(1.02, 1.14), respectively. A significant association was found in adjusted and crude studies. There is no significant association between labor induction and ASD in case-control studies (OR=1.08, 95% CI = 0.99, 1.17). Conclusion: The findings showed that labor induction is associated with an increased risk of ASD among children. Therefore, the findings support that clinical use of oxytocin during labor has a significant negative impact on the long-term mental health of children.

BackgroundMain aims of the present paper are to: (1) assess the prevalence of antenatal depression (AD) and identify its predictors; (2) analyse the impact of AD on obstetric outcomes and on the incidence of post-partum depression.MethodsAll pregnant women referring to the Gynecology and Obstetrics inpatients unit of the University of Campania “Luigi Vanvitelli” were invited to participate. Upon acceptance, women completed the Italian version of the Edinburgh Postnatal Depression Scale and an ad-hoc questionnaire on the women's sociodemographic, gynecological and peripartum characteristics as well as their psychiatric history. Women were assessed at each trimester of pregnancy, immediately after the childbirth and after one, three, 6 and 11 months.Results268 pregnant women were recruited, with a mean of 32.2 (±5.81) years. Ninety-seven women (36.2%) reported the presence of depressive symptoms during pregnancy. Predictors of AD were personal history of depression, a family history for depressive disorders and problematic relationships with the partner. The presence of AD was associated to a reduced gestational age at the time of delivery, a lower APGAR score at 1 and 5 min, labor induction and admission of the new-born into neonatal intensive care unit. Mothers with antenatal depression are less likely to natural breastfeed. Lastly, antenatal depression was a risk factor for higher EPDS scores at follow-ups.ConclusionsOur results support the idea that women should be screened during pregnancy and post-partum for the presence of depressive and anxiety symptoms. Health professionals should be adequately trained to detect psychiatric symptoms during pregnancy.

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.

Objective Preventing the first cesarean delivery (CD) is important as CD rates continue to rise. During the novel coronavirus disease 2019 (COVID-19) pandemic, quality improvement metrics at our hospital identified lower rates of CD. We sought to investigate this change and identify factors that may have contributed to the decrease. Study Design We compared nulliparous singleton deliveries at a large academic hospital during the COVID-19 pandemic (April through July 2020 during a statewide “stay-at-home” order) to those in the same months 1 year prior to the pandemic (April through July 2019). The primary outcome, mode of delivery, was obtained from the electronic medical record system, along with indication for CD. Results The cohort included 1,913 deliveries: 892 in 2019 and 1,021 in 2020. Patient characteristics (age, body mass index, race, ethnicity, and insurance type) did not differ between the groups. Median gestational age at delivery was the same in both groups. The CD rate decreased significantly during the COVID-19 pandemic compared with prior (28.9 vs. 33.6%; p = 0.03). There was a significant increase in the rate of labor induction (45.7 vs. 40.6%; p = 0.02), but no difference in the proportion of inductions that were elective (19.5 vs. 20.7%; p = 0.66). The rate of CD in labor was unchanged (15.9 vs. 16.3%; p = 0.82); however, more women attempted a trial of labor (87.0 vs. 82.6%; p = 0.01). Thus, the proportion of CD without a trial of labor decreased (25.1 vs. 33.0%; p = 0.04). Conclusion There was a statistically significant decrease in CD during the COVID-19 pandemic at our hospital, driven by a decrease in CD without a trial of labor. The increased rate of attempted trial of labor suggests the presence of patient-level factors that warrant further investigation as potential targets for decreasing CD rates. Additionally, in a diverse and medically complex population, increased rates of labor induction were not associated with increased rates of CD. Key Points

Objective We aimed to determine the risk of cesarean among women with obesity undergoing labor induction within a prospective trial that utilized a standardized labor protocol. Study Design This was a secondary analysis of a randomized trial of induction methods. Term (≥37 weeks) women with intact membranes undergoing induction with an unfavorable cervix (Bishop's score ≤6 and dilation ≤2 cm) were included. The trial utilized a labor protocol that standardized induction and active labor management, with recommendations for interventions at particular time points. Only women with a recorded body mass index (BMI) at prenatal care start were included in this analysis. The primary outcome was cesarean delivery compared between obese (≥30 kg/m2) and nonobese ( Results A total of 465 women were included: 207 (44.5%) obese and 258 (55.5%) nonobese. Women with obesity had a higher risk of cesarean compared with women without obesity (33.3 vs. 23.3%, p = 0.02), even when adjusting for parity, weight change over pregnancy, and indication for induction (adjusted relative risk [aRR] = 1.79, 95% confidence interval [CI]: [1.34–2.39]). Compared with women without obesity, women with obesity had a higher risk of failed induction (47.8 vs. 26.7%, p = 0.01) without a difference in arrest of active phase (p = 0.39), arrest of descent (p = 0.95) or fetal indication (p = 0.32), despite adherence to a standardized labor protocol. Conclusion Compared with women without obesity, women with obesity undergoing an induction are at increased risk of cesarean, in particular a failed induction, even within the context of standardized induction management. As standardized practices limit provider variation in labor management, this study may support physiologic differences in labor processes secondary to obesity. Key Points

The incidence of labor induction with various indications was to increase. The key to successful labor induction is a ripe cervix. Research shows that the degree of cervical rippening as assessed by the Bishop score is influenced by the level of neutrophils contained in the cervical stroma which can be detected by performing a vaginal swab. Neutrophils will produce collagenase in the form of matrix metalloproteinase - 8 (MMPs - 8) which will degrade cervical collagen fibers, so that the cervix becomes soft and ripe. Misoprostol is the drug most widely used in labor induction today. Purpose: This study was to determine the difference in Bishop score increase between vaginal swab neutrophils ≤ 5 and > 5 in pregnancy ≥ 41 weeks induced by misoprostol.Keywords: Bishop score, neutrophil, vaginal swab, misoprostol

The physiological pattern of hormonal and signaling molecules associated with labor induction is not fully clear. We conducted a preliminary study in order to investigate hormonal changes during labor induction in women with previous cesarean section. Eighty-seven women at term, with previous cesarean section, were randomized to undergo induction of labor by breast stimulation or intracervical balloon and compared with spontaneous labor (controls). Maternal serum levels of oxytocin, prostaglandin F2α, prostaglandin E2, prolactin, estradiol, and cortisol were analyzed at 0, 3, and 6 h post-induction initiation. Fetal umbilical cord hormones were measured. No significant difference was found in the induction-to-delivery time or mode of delivery between the induction groups. Maternal serum oxytocin levels decreased to a lesser extent in the breast stimulation group vs. the control group (p=0.003, p

Objective To estimate the effect of elective induction of labour at 39 weeks of gestation on children's educational outcomes as measured by the Australian National Assessment Program-Literacy and Numeracy (NAPLAN) tests at year 3 (~8 years of age), compared with expectant management. Methods We merged perinatal data, including information regarding all infants in South Australia from 1999 to 2008, with children's school assessment data (i.e., NAPLAN data). The study population included all singleton births born without malformations at 39-42 weeks of gestation in vertex presentation. Children had to have undertaken year-3 NAPLAN (~8 years of age). We excluded births from women who had a contraindication to vaginal delivery and with conditions possibly justifying elective delivery before 39 weeks of gestation. Our outcome of interest was children's educational outcomes as measured by NAPLAN. The NAPLAN included five learning domains (reading, writing, spelling, grammar and numeracy). Each domain was categorised according to performing at or below versus above the National Minimum Standards (NMS). Average Treatment Effects (ATEs) of elective induction of labour at 39 weeks for children performing at/below the NMS for each domain were estimated using Augmented Inverse Probability Weighted (AIPW) estimator accounting for potential confounders. Results Among 53,843 children born at 39-42 weeks with vertex presentation from 1999-2008 and those who were expected to participate in year 3 NAPLAN from 2008-2015, a total of 31,120 children had at least one year 3 NAPLAN domain. Of these (i.e., 31,120 children), 1,353 children were delivered after elective induction of labour at 39 weeks while 29,767 children were born following expectant management. The ATEs (mean differences) comparing elective induction of labour at 39 weeks with expectant management for children scoring at/below the NMS on each domain were: reading (0.01 (95% CI -0.02 to 0.03)), writing (0.02 (95% CI 0.00 to 0.04)), spelling (0.01 (95% CI -0.01 to 0.04)), grammar (0.02 (95% CI -0.01 to 0.04)) and numeracy (0.03 (95% CI -0.00 to 0.05)). Conclusion Elective induction of labour at 39 weeks of gestation did not affect children's standardised literacy and numeracy testing outcomes at eight years of age when compared with expectant management. This article is protected by copyright. All rights reserved.

The response to perinatal hypoxia, developing in stimulating generic activity, is the activation of microglia, which induces the development of local inflammation of the brain and leads to the death of neurons. The formation of the hippocampus supports important physiological and behavioral functions, including spatial learning and memory, and is part of the brain, which is especially vulnerable to changes in blood glucose and oxygen. Thus, the study of the features of the development of hippocampal formation in the postnatal period after stimulating generic activity is relevant. The purpose of the study was to study the features of Glial fibrillary acidic protein and NeuN expression in the hippocampal formation in posterity of female rats after PgE2 injection for labor induction. Materials and methods. Pregnant females of the experimental group on the twenty-second day of pregnancy were injected intravaginally with PGE2 in the form of a gel to stimulate the generic activity. Birth occurred on the twenty-third day after conception. Birth in the intact group of rats occurred on the 23-24th day after conception. The large hemispheres of the rat brain were fixed in a 10% neutral formal solution, dehydrated in an ascending alcohol battery. For immunohistochemical studies, paraffin sections were used with 3 microns with a thickness of 3 microns. Glial fibrillary acidic protein Mouse Monoclonal Antibody (Santa Cruz Biotechnology, Inc.) is used to detect astrocytes (Santa Cruz Biotechnology, Inc.). NeuN Mouse Monoclonal Antibody (Santa Cruz Biotechnology, Inc.) was used to identify neurons on the 1st, 7th, 14th, 45th days after birth in histological cuts of hippocampus and gear, using a program for analyzing and processing images Image J, studied the relative area occupied by Glial fibrillary acidic protein + NeuN + cells. Data is processed by variation statistics. The results are reliable at p

Obesity has been identified mainly as a raise in the body’s adiposity leading to prolonged overshoot of caloric intake over expenditure. Obesity has significant health-altering implications which have been shown to be implicated in the pathogenesis and progression of other diseases through its extensive physiological assaults. The prevalence of overweight and obesity has been an increasing epidemic worldwide. The number of obese births was even on the increase, with an increasing number of women of reproductive age registering as obese. Obesity is related to adverse perinatal outcomes and increased morbidity and mortality in pregnant women. The potential risk for multiple antenatal, postpartum, intrapartum, and neonatal complications is maternal obesity. Greater risk of developing Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), pre-eclampsia, risk of venous embolism, increased need for labor induction, and cesarean sections in the mother have been recorded in a comprehensive analysis of pregnancy complications associated with obesity. The link between obesity, gestational diabetes, and pregnancy outcomes will be briefly shown in this article.

To determine the relationship between maternal age and labor induction duration among nulliparous women.This retrospective cohort study included nulliparous women with non-anomalous, term, singleton pregnancies undergoing labor induction with intact membranes at a tertiary-care academic hospital from January 2015 to April 2017. Maternal age was stratified as follows:25 years, 25-29 years, 30-34 years, 35-39 years, and ≥ 40 years. The primary outcome was induction duration, defined as the time the first induction agent was administered to time of birth. Secondary outcomes were cesarean delivery, cesarean indication, hemorrhage, blood transfusion, peripartum infection, composite neonatal morbidity, and induction duration among the subset of women who ultimately underwent cesarean. The data were analyzed using chi-squared and Fisher exact tests. Multivariable regression was used to adjust for maternal race/ethnicity, maternal body mass index, gestational age at start of induction, and induction indication. Hazard ratios were used to calculate induction duration among women who underwent cesarean delivery, stratified by age and adjusted by the same variables.Among the 955 patients included, the median induction duration was 32.3 h (interquartile range (IQR) 20.4-41.0 h). Women 40 years and older had a slight increase in induction duration (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.01-1.05) and a seven-fold increased risk of induction lasting 60 h or longer (adjusted relative risk (aRR) 7.3, CI 1.8-29.9) when compared to those under 25 years of age; otherwise, there was no association between maternal age and labor induction duration. There was no association between age and cesarean delivery, cesarean indication, hemorrhage, transfusion, peripartum infection, or adverse neonatal outcomes. Furthermore, there was no association between maternal age and induction duration even among women who ultimately underwent cesarean.We found no association between maternal age and induction duration for women under 40 years of age. For women 40 years of age and older, these was an increased risk of labor induction lasting 60 h or longer. Despite this, we found no association between maternal age and cesarean delivery or other adverse maternal or fetal outcomes.

Background Pregnancy-related cardiovascular physiologic changes increase the likelihood of pulmonary edema, with the risk of fluid extravasating into the pulmonary interstitium being potentially at a maximum during the early postpartum period. Data on the impact of labor and peripartum hemodynamic strain on lung ultrasound (LUS) are limited, and the prevalence of subclinical pulmonary interstitial syndrome in peripartum women is poorly described. The primary aim of this exploratory study was to estimate the prevalence of pulmonary interstitial syndrome in healthy term parturients undergoing vaginal (VD), elective (eCD), and unplanned intrapartum cesarean deliveries (uCD). Secondary aims were to estimate the prevalence of positive lung regions (≥3 B-lines on LUS per region) and to assess the associations between positive lung regions and possible contributing factors. Methods In this prospective observational cohort study, healthy women at term undergoing VD, eCD, or uCD were enrolled. Following international consensus recommendations, a LUS examination was performed within 4 hours after delivery applying an 8-region technique. Pulmonary interstitial syndrome was defined by the presence of 2 or more positive lung regions per hemithorax. Ultrasound studies were reviewed by 2 blinded reviewers and assessed for interobserver reliability. Results Seventy-five women were assessed (n = 25 per group). No pulmonary interstitial syndrome was found in the VD and eCD groups (each 0 of 25; 0%, 95% confidence interval [CI], 0-13.7). Pulmonary interstitial syndrome was found in 2 of 25 (8%, 95% CI, 1-26) women undergoing an uCD (P = .490 for VD versus uCD and P = .490 for eCD versus uCD). In 1 woman, this correlated clinically with the development of pulmonary edema. One or more positive lung regions were present in 5 of 25 (20%), 6 of 25 (24%), and 11 of 25 (44%) parturients following VD, eCD, and uCD, respectively (P = .136). Positive lung regions were predominantly found in lateral lung regions. The number of positive lung regions showed a weak correlation with patient age (r = 0.25, 95% CI, 0.05-0.47; P = .033). No significant association was found between LUS pattern and parity, duration of labor, labor augmentation, labor induction, estimated total intravenous fluid intake, or net intravenous fluid intake. Conclusions Although many focal areas of increased extravascular lung water (20%-44% prevalence) can be identified on LUS, the overall prevalence of pulmonary interstitial syndrome was 2.7% (2 of 75; 95% CI, 0.3-9.3) among healthy term parturients soon after delivery. Focal areas of positive lung water regions were weakly correlated with maternal age.

INTRODUCTION Labor induction rates are increasing and, in Finland today, one of three labors is induced. Group B streptococcus (GBS) is a bacterium found in 10%-30% of pregnant women and it can be transmitted to the neonate during vaginal delivery. Although GBS is rarely harmful in the general population, it is the leading cause of severe neonatal infections such as sepsis, pneumonia, and meningitis. In addition, GBS can cause maternal morbidity. Labor induction in GBS-positive women has not yet been investigated but concerns of infectious morbidity associated with balloon catheters have been raised. MATERIAL AND METHODS A historical cohort study of 1959 women undergoing labor induction by balloon catheter in Helsinki University Hospital, Finland, between January 1, 2014 and December 31, 2017. Women with viable singleton term pregnancy in cephalic presentation, unfavorable cervix (Bishop score

Introduction Induction of labor is increasing. A common indication for induction of labor is late term and postterm pregnancy at 41 weeks or more. We aimed to evaluate if there are any differences regarding efficacy, safety, and women's childbirth experience between oral misoprostol and transvaginal balloon catheter for cervical ripening in women with a low-risk singleton pregnancy and induction of labor at 41+0 to 42+0 to 1 weeks of gestation. Material and methods In this observational study, based on data from the Swedish Postterm Induction Study (SWEPIS), a multicenter randomized controlled trial, a total of 1213 women with a low-risk singleton pregnancy at 41 to 42 weeks of gestation were induced with oral misoprostol (n = 744) or transvaginal balloon catheter (n = 469) at 15 Swedish delivery hospitals. The primary efficacy outcome was vaginal delivery within 24 h and primary safety outcomes were neonatal and maternal composite adverse outcomes. Secondary outcomes included time to vaginal delivery and mode of delivery. Women's childbirth experience was assessed with the Childbirth Experience Questionnaire (CEQ 2.0) and visual analog scale. We present crude and adjusted mean differences and relative risks (RR) with 95% CI. Adjustment was performed for a propensity score based on delivery hospital and baseline characteristics including Bishop score. Results Vaginal delivery within 24 h was significantly lower in the misoprostol group compared with the balloon catheter group (46.5% [346/744] versus 62.7% [294/469]; adjusted RR 0.76 95% CI 0.640.89]). Primary neonatal and maternal safety outcomes did not differ between groups (neonatal composite 3.5% [36/744] vs 3.2% [15/469]; adjusted RR 0.77 [95% CI 0.31-1.89]; maternal composite 2.3% [17/744] versus 1.9% [9/469]; adjusted RR 1.70 [95% CI 0.58-4.97]). Adjusted mean time to vaginal delivery was increased by 3.8 h (95% CI 1.3-6.2 h) in the misoprostol group. Non-operative vaginal delivery and cesarean delivery rates did not differ. Women's childbirth experience was positive overall and similar in both groups. Conclusion Induction of labor with oral misoprostol compared with a transvaginal balloon catheter was associated with a lower probability of vaginal delivery within 24 h and a longer time to vaginal delivery. However, primary safety outcomes, non-operative vaginal delivery, and women's childbirth experience were similar in both groups. Therefore, both methods can be recommended in women with low-risk postdate pregnancies.

The evening primrose oil has prostaglandin effects and is applied to soften the cervix. This systematic review and meta-analysis aimed to establish the results of clinical trials performed on the effect of evening primrose oil on labor induction and cervical ripening in pregnant women. Research studies were searched from 1990 to September 2019 in Pubmed, Science Direct, Embase, and Cochrane Library using the keywords: cervical ripening, Bishop score, labor induction, post-term pregnancy, evening primrose, and any possible combination of these keywords (Farsi, English). Data analysis was conducted using STATA (version 14.1), and I2 index and random effect forest plots to assess the heterogeneity between the studies and perform the meta-analysis, respectively. Six articles that met the inclusion criteria were extracted in which four were entered into quantitative meta-analysis. The results' high heterogeneity was 91.4% based on I2 index (p ≤ .001) and the random model was applied for meta-analysis. The result demonstrated no significant difference between the intervention and control groups in terms of mean difference of the Bishop score before and after intervention (SMD: 0.27, 95%CI: -0.41, 0.96, p = .43). Based on current meta-analysis on four studies, effectiveness of oral consumption of evening primrose on cervical ripening was not approved.

OBJECTIVE: Standardized labor induction protocols utilizing evidence-based active management practices are associated with improved obstetric outcomes. However, these protocols are complex and include multiple components. We aimed to identify which of the individual components of an evidence-based labor induction protocol are most associated with reduced rates of cesarean delivery, maternal morbidity, and neonatal morbidity. STUDY DESIGN: This is a secondary analysis of a randomized trial comparing time to delivery among four labor induction methods. All patients enrolled in the trial had their labor managed with a multidisciplinary-developed, evidence-based standardized labor induction protocol. For each patient’s induction, we assessed adherence to seven components of the protocol. Primary outcomes included cesarean delivery, maternal morbidity, and neonatal morbidity. Bivariate analyses assessed the association of each protocol component with each outcome. Multivariable logistic regression determined independent predictors of each outcome. RESULTS: The 491 patients enrolled in the randomized trial were included in this analysis. For cesarean delivery, while adherence to four of the seven protocol components was associated with the outcome in bivariate analyses, only adherence to “cervical exams should be performed every 1–2 h in active labor” was associated with reduced cesarean rates when controlling for age, body mass index, and parity. For maternal morbidity, while adherence to “if misoprostol is utilized, it should not be continued beyond 6 doses or 24 h of use” was associated in bivariate analysis, it was no longer associated with the outcome in multivariable analysis. Finally, “cervical exams should be performed every 1–2 h in active labor” and “cervical exams should be performed every 2–4 h in latent labor” were associated with reduced neonatal morbidity both in bivariate analyses as well as when controlling for age, body mass index, and parity. CONCLUSIONS: Within a standardized labor induction protocol, adherence to cervical exams every 1–2 h in active labor was associated with reduced cesarean rate, and adherence to cervical exams every 2–4 h in latent labor, as well as every 1–2 h in active labor is associated with reduced neonatal morbidity. Regular cervical examination during labor induction likely allows for intervention when cervical change is not made. This data warrants further investigation into the optimal frequency of cervical exams during labor induction. Furthermore, an understanding of which components of a complex, evidence-based labor induction protocol are most effective may be helpful for streamlining and education around this protocol as implementation occurs across diverse sites.

Background: During the first 36 to 38 weeks of normal gestation, the myometrium is in a preparatory yet unresponsive state. Concurrently, the cervix begins an early stage of remodeling yet maintains structural integrity. Induction of labour is a complex process involving cervical ripening which undergo extensive remodeling and dynamic changes controlled by hormonal, inflammatory changes, and other biological processes. Aim of the Work: to assess the effect of intravenous administration of dexamethasone on the induction delivery interval in term patients with prelabour rupture of membranes undergoing induction of labor. Patients and Methods: This randomized control trial was conducted at department of Obstetrics and Gynecology at Ain Shams University Maternity Hospital (ASUMH) in the period between August 2020 and January 2021. Participants of this study were 80 full term pregnant women with pre-labor rupture of membranes attended the labor ward in El Demerdash Maternity Hospital and scheduled for induction of labor by 8 mg dexamethasone IV before starting induction by PGE1, after 4 hours oxytocin was added by 1 IU/hr with the dose increasing by 1 IU every 30 minutes till optimal contractions were reached which were three uterine contractions in 10 minutes and each lasting for 40-50 seconds. Results: Fetal distress, arrest of delivery and indications of CS delivery were non-significantly less frequent among Dexamethasone group. Induction-active phase and active phase durations were significantly shorter among dexamethasone group than among control group. Second and third stages durations were non-significantly shorter among dexamethasone group than among control group. Total induction-delivery duration was significantly shorter and rate of vaginal delivery was significantly higher among dexamethasone group than among control group. Postpartum hemorrhage (PPH), postpartum endometritis, chorioamnionitis were not reported among the studied groups. No significant difference between Dexamaethasone and Control groups regarding neonatal condition Conclusion: Intravenous administration of dexamethasone in addition to labor induction protocol shortened the induction - active phase and active phase durations. It shortened the total induction-delivery duration and increased the rate of successful vaginal delivery. It has no effect on second and third stages durations with no increase in incidence of intrapartum, postpartum nor neonatal complications.

Background: Induction of labour has risen gradually in modern obstetrics all over the world. It is more predominant in developed countries (around 20%) than developing countries. Objectives: To evaluate the outcome of induction of labor in primiparous, multiparous women and the risk of cesarean delivery associated with induction. Patients and methods: This study included 200 patients attending to Obstetrics and Gynecological Department at Al-Hussein University Hospital for delivery and Al-Sinblawein General Hospital from September 2019 to April 2020. The patients were classified into two equal groups according to success of induction: Group 1 was given misoprostol vaginally after rupture of membrane, group 2 patients was give oxytocin by slow infusion after rupture of membrane. Patients with gestational age less than 37 weeks, previous cesarean delivery, with breech presentation and age above 40 years were excluded. Results: There was a statistically significant difference between group 1(misoprostol) and group 2 (oxytocin) regarding induction of labor with mean interval between hours was higher in group 2. Conclusion: Vaginal misoprostol was effective, easy to administer, safe method and superior to oxytocin for induction of labor.

Objective To assess the correlation between in vitro fertilization (IVF) and complications of the third stage of labor. Design Retrospective cohort of vaginal deliveries from November 2008 to January 2020. Maternal and obstetric outcomes of singleton deliveries were compared between IVF and non-IVF pregnancies. Setting University hospital. Patient(s) Women with live singleton vaginal deliveries at >24 weeks of gestation. Intervention(s) In vitro fertilization–attained pregnancies (compared with spontaneous ones). Main Outcome Measure(s) Complications of the third stage of labor, defined as manual placental removal (either entire removal due to nonseparation or exploration of the uterine cavity due to suspected retained products of conception). Result(s) Overall, 1,264 IVF pregnancies and 34,166 non-IVF pregnancies were included. Deliveries in the IVF group were characterized by an older maternal age, lower parity, higher rate of diabetes and hypertensive disorders, higher rate of placental abnormalities, earlier gestational age, higher rate of labor induction, chorioamnionitis, and instrumental delivery. Complications of the third stage of labor occurred in 5.9% of IVF deliveries and in 2.8% of controls, and blood transfusion was more prevalent in IVF deliveries. The rate of complications of the third stage were higher in both fresh and frozen transfer cycles as compared with spontaneous pregnancies (5.8%, 8.8%, and 2.8%, respectively), although no difference was noted between fresh and frozen transfers. In vitro fertilization was associated independently with complications of the third stage of labor after adjustment for potential confounders. Conclusion(s) In vitro fertilization is associated independently with an increased risk of complications of the third stage of labor.

Background: Labor induction is a procedure to stimulate uterine contractions during pregnancy before labor begins on its own to achieve a vaginal birth with medical or mechanical intervention to start the labor. This procedure aims to stimulate more extensive contraction in the uterus. The labor induction can reduce the caesarean rate. Prostaglandin E2 (PGE2) and misoprostol are the commonest medicine used to ripen the cervix in the Dr. Soetomo Hospital. Objective: Our study aim to evaluate the success rate of induction of labor patient. Methods: This study was a descriptive study using the medical record in 2018 in the Dr. Soetomo General Hospital, Surabaya. A total of 183 patient’s medical record data who underwent induced labor were used in this study. Inclusion criteria were the women with indication to deliver and have no cephalo-pelvic disproportion. Women with contraindication labor induction were excluded. Data was described using table and narrative approach. Results: The most range of gestational age was 21-36 weeks (53.01%) followed by 37-42 weeks (42.07%). There were 68 patients (37,1%) primigravida and 115 patients (62,8%) were multipara. The major induced labor was conducted with misoprostol (78.6%), and the most pelvic scores were 2 (58.46%) before underwent induced labor. Vertex delivery was the preferred mode of delivery after the induction of labor with 89 patients (48,62%). The labor induction failure followed with the caesarean operation were 27 patients (14,7%) and one patient (0,54%) with hysterotomy, most of them caused by failure to progress and fetal distress. There were 78 babies (43%) with the weight over 2500 g, 28 babies (31%) were over 2000 g, and the other was below 2000 g. A total of 84.71% with labor induction can be delivered vaginally, and It is a good number to reduce the rate of caesarean operations. Conclusion: This study concludes that misoprostol uses for the induction of labor than the other. Delivery abdominal is less percentage than the additional delivery finds that as a failure of induction of labor. The Labor induction success to delivered vaginally can reduce the rate of caesarean operation.

Objectives We compared delivery characteristics and outcome of women with stillbirth to those with live birth. Methods This was a retrospective case-control study from Helsinki University Hospital, Finland. The study population comprised 214 antepartum singleton stillbirths during 2003–2015. Two age-adjusted controls giving live birth in the same year at the same institution were chosen for each case from the Finnish Medical Birth Register. Delivery characteristics and adverse pregnancy outcomes were compared between the cases and controls, adjusted for gestational age. Results Labor induction was more common (86.0 vs. 22.0%, p Conclusions Most women with stillbirth delivered vaginally without obstetric complications. The duration of labor was shorter in pregnancies with stillbirth but the risk for postpartum interventions and bleeding complications was higher compared to those with live birth.

OBJECTIVE To estimate the incidence of failed induction of labor and the associated patient risk factors. METHODS We performed a case-control study from a cohort of nulliparous women who delivered between 39 and 41 weeks of gestation after an induction of labor in one of seven hospitals. Cases of failed induction were defined using the Obstetric Care Consensus criteria (ie, cesarean delivery performed in early labor [less than 6 cm dilatation] after at least 12 hours of oxytocin administration from membrane rupture). For each case of failed induction, the next four women who did not meet the criteria for failed induction of labor were selected for the control group, matched by hospital. We identified characteristics associated with failed induction of labor using a multivariable conditional logistic regression that was constructed with backward stepwise method for variable selection. RESULTS Across the hospitals, 4,123 of 10,175 nulliparous women were induced (40.5%), of whom 82 had a failed induction of labor (2.0%). A total of 328 women were selected for the matched control group. Baseline characteristics were similar between the groups. Compared with women in the control group, women with a failed induction were more likely to have a delivery body mass index (BMI) of 40 or higher (28.0 vs 8.2%, P

Induction of labor continues to become more common. We analyzed induction of labor and timing of obstetric and anesthesia work to create a model to predict the induction-anesthesia interval and the induction-delivery interval in order to co-ordinate workload to occur when staff are most available.Patients who underwent induction of labor at a single medical center were identified and multivariable linear regression was used to model anesthesia and delivery times. Data were collected on date of birth, race/ethnicity, body mass index, gestational age, gravidity, parity, indication for labor induction, number of prior deliveries, time of induction, induction agent, cervical dilation, effacement, and fetal station on admission, date and time of anesthesia administration, date and time of delivery, and delivery type.A total of 1746 women met inclusion criteria. Associations which significantly influenced time from induction of labor to anesthesia and delivery included maternal age (anesthesia P0.001, delivery P =0.002), body mass index (both P0.001), prior vaginal delivery (both P0.001), gestational age (anesthesia P0.001, delivery P0.018), simplified Bishop score (both P0.001), and first induction agent (both P0.001). Induction of labor of nulliparous women at 02:00 h and parous women at 04:00 or 05:00 h had the highest estimated probability of the mother having her first anesthesia encounter and delivering during optimally staffed hours when our institution's specialty personnel are most available.Time to obstetric and anesthesia tasks can be estimated to optimize induction of labor start times, and shift anesthesia and delivery workload to hours when staff are most available.

Objective To evaluate the rate of preterm birth (PTB) in a subsequent pregnancy in women who had undergone term induction using a Foley catheter compared with prostaglandins. Methods This was a follow‐up study of two large randomized controlled trials (PROBAAT‐1 and PROBAAT‐2). In the original trials, women with a term singleton pregnancy with the fetus in cephalic presentation and with an indication for labor induction were randomized to receive either a 30‐mL Foley catheter or prostaglandins (vaginal prostaglandin E2 in PROBAAT‐1 and oral misoprostol in PROBAAT‐2). Data on subsequent ongoing pregnancies > 16 weeks’ gestation were collected from hospital charts from clinics participating in this follow‐up study. The main outcome measure was preterm birth 16 weeks' gestation in the Foley catheter and prostaglandin groups, respectively. There were no differences in baseline characteristics between the groups. The overall rate of PTB in a subsequent pregnancy was 9/251 (3.6%) in the Foley catheter group vs 10/258 (3.9%) in the prostaglandin group (relative risk (RR), 0.93; 95% CI, 0.38–2.24), and the rate of spontaneous PTB was 5/251 (2.0%) vs 5/258 (1.9%) (RR, 1.03; 95% CI, 0.30–3.51). Conclusion In women with term singleton pregnancy, induction of labor using a 30‐mL Foley catheter is not associated with an increased risk of PTB in a subsequent pregnancy, as compared to induction of labor using prostaglandins. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

In this month's issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we highlight a review of low-dose oral misoprostol for labor induction, strategies to increase continuation of shorter-term hormonal contraception, and early postnatal discharge. The summaries are published below. The complete references with hyperlinks are listed in Box 1.

Objective: To evaluate the impact of obesity on maternal and neonatal outcome. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship, Shifa HospitalKarachi, from Nov 2016 to Oct 2017. Methodology: All singleton pregnant women of normal prepregnancy body mass index (BMI) and obese women having ≥30 body mass index, delivering newborn at 28-42 weeks of gestation were included. Comparison of antenatal complications and neonatal outcomes was done among both groups. Results: Obese women significantly developed gestational hypertension (OR=7.4 95% CI, 4.84-11.4), preeclampsia (OR=2.22 95% CI, 1.36-3.6), gestational diabetes mellitus (OR=5.2; 95% CI, 3.57-7.58), labor induction (OR= 2.79 95% CI, 2.03-3.84), failed induction of labor (OR = 5.3 95% CI, 8.05-29.38), cesarean delivery (OR=1.89 95% CI, 1.41-2.5), large for gestational age newborn (OR=3.97 95% CI, 2.87-5.50). But there was no statistically significant difference in small for gestational age newborn (OR=0.91 95% CI, 0.42-1.98), new born with APGAR score ≤7 after 5 min after delivery (OR=2.168 95% CI, 0.97-4.82) among obese and normal weight pregnant women. Conclusion: There is increased risk of gestational hypertension, preeclampsia, gestational diabetes, failed induction of labor, dystocia, cesarean delivery and large for gestational age newborns in obese women.Keywords: , , , ,

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.

Objectives: The objectives of this study were to evaluate the diagnostic abilities of the cerebroplacental ratio (CPR) for the prediction of adverse perinatal outcome (APO) and cesarean section for intrapartum fetal compromise (CS-IFC) within 1 day of delivery. Design: Retrospective observational case-control study. Methods: This was a study of 254 high-risk fetuses attending the day hospital unit of a tertiary referral hospital that underwent an ultrasound examination at 32–41 weeks and gave birth within 1 day of examination. APO was defined as a composite of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH Results: CPR in multiples of the median (MoM) was a moderate predictor of APO (area under the curve [AUC] = 0.77, p < 0.0001) and CS-IFC (AUC = 0.82, p < 0.0001). The predictive abilities of the multivariable model for APO (AUC = 0.81, p < 0.0001) and CS-IFC (AUC = 0.82, p < 0.0001) did not differ from those of CPR alone . Limitations: The small number of cases and the scarcity of information concerning labor induction. Conclusion: In high-risk pregnancies, CPR MoM is a moderate predictor of APO and CS-IFC when performed within 24 h of delivery.

Backgrounds: Induction of labor is a common practice. In women with immature cervix, PGE2 is commonly used for pre-induction. We hypothesized that PGE2 1.5 mg may be equally effective to PGE2 3 mg in multiparous women for labor induction. The present effort was an attempt to compare the efficacy and effects of pre-induction cervical ripening with PGE2 3 mg vs. 1.5 mg in multi-parous mothers (2nd and 3rd Pregnancy) at 40 weeks. Methods: A double-blind randomized controlled trial was carried out at Castle Street Hospital for Women, Colombo, Sri Lanka. Study subjects consisted of women with singleton pregnancy (no cesarean history) admitted for delivery at 40 weeks of their 2nd or 3rd pregnancy. PGE2 1.5 mg vs. 3 mg PGE2 vaginal tablet were used for treatment (n = 173) and control (n = 170) groups, respectively. Cervical ripening and maternal, fetal complications were observed. Unfavorable cervices were induced with the same PGE2 dose in the following day. Results: Study group, compared with the control group, achieved the same rate of favorable cervices in 1st and 2nd cycles (63.5% vs. 64%, respectively). Both groups showed the same rate of cervical dilatation achievement, and admissions to Special Care Baby Unit. Study group showed significantly less maternal complications (4% and 11%, respectively: p = 0.01). Conclusion: PGE2 of 1.5 mg is equally effective in achieving favorable cervices, adequate cervical dilatation with minimum maternal complications compared to the usual 3 mg dose in multiparous low-risk women.

Background: Induction of labor is usually performed when the risks of continuing pregnancy are higher than the benefits of delivery. Uterine cervical tissue ripening or its softening has a close relationship with success rate of delivery. Objective: To compare the safety and effectiveness of sublingual misoprostol with combined sublingual misoprostol and vaginal estradiol for induction of labor in unfavorable cervix. Subjects and methods: This was a prospective single blinded study conducted in Obstetrics and Gynecology Departments, El-Hussein University Hospital ELAlamin Standard Hospital, Matrouh including 160 women with unfavorable cervix and gestation ≥ 40 till 42 weeks with clinical indication for induction of labor. They would be randomly assigned to either the misoprostol+ placebo or misoprostol+ estradiol. The duration of the study was 12 months from 01 May 2019 till 01 may 2020. Results: Women’s Time to active labor in women with misoprostol+ placebo ranged between 5-9 hours with mean± S.D. 6.99±1.419 hours while in women with misoprostol+ estradiol was ranged between 5-9 hours with mean± S.D. 6.96±1.400 hours. There were no statistically significant differences between groups. Conclusion: Sublingual misoprostol alone was as effective as sublingual misoprostol and vaginal Estradiol for induction of labor at term.

Introduction: Induction of labor has become an increasingly utilized obstetric intervention in developed countries. It contributes to reduce the maternal and perinatal morbidity and mortality. Dinoprostone derivatives are often used under cardiotocography. In poor countries, health structures have neither fetal monitoring, nor means of preserving Dinoprostone derivatives. Misoprostol therefore constitutes an alternative. This study seeks to establish the efficacy and safety of oral Misoprostol and to assess maternal and perinatal prognosis in an area with limited resource. Methods: This is a multi-center clinical trial, conducted in 3 hospitals centers in Kisangani, Tshopo Province/Democratic Republic of Congo from December 1, 2020 to May 31, 2021. Our sample was constituted with 68 pregnant women with term pregnancy. Fifty micrograms of Misoprostol was administered orally. The data were collected prospectively, their encoding was carried out on an Excel sheet 2013 and their analysis carried out using the EPI INFO software. Results: The average age of the pregnant women was 23.17 ± 5.76 years. The average parity was 1.02 ± 1.2. The average body mass index (BMI) was 24.98 ± 2.55 Kg/m2. 66 (97.1%) patients had received a maximum of 3 doses of Misoprostol. Out of the 16 parturients who received 3 doses or more, 11 (68.8%) had a BMI ≥ 25. The average duration of labor was 16.03 ± 7.99 hours. 66 (97.1%) pregnant women had delivered vaginally. 57 (83.8%) patients delivered within 24 hours. Out of the 11 patients who delivered after 24 hours, 7 (63.6%) had a BMI ≥ 25. The induction failure rate was 2.9% (2 patients). 2 (2.9%) fetuses had presented pathological modification of fetal heart rate (FHR). 2 (2.9%) patients had undergone cesarean section. Conclusion: Labor induction with oral Misoprostol is effective and associated with low maternal and perinatal morbidity. A BMI ≥ 25 kg/m2 increases the number of doses to be given and the duration of labor.

Background: Cervical ripening is prerequisite of successful induction of labor. Vaginal misoprostol and Foley’s catheter placement have been widely used for this purpose but the data are not always sufficient. We attempted to determine which (misoprostol versus Foley’s catheter) is more effective/safer in Nigerian setting. Methods: A randomized controlled trial was performed at Federal Teaching Hospital Abakaliki, Nigeria, involving 135 term pregnant women requiring cervical ripening and labor induction. Participants were randomly allocated to misoprostol versus catheter group. The following were recorded/measured/analyzed: Bishop’s score, age, parity, body mass index, gestational age, labor duration, indication, oxytocin use, mode of delivery, and Apgar score. Chi square test and t test were used where appropriate. Results: At 24 hours, all of misoprostol group were either in labor, had ripe cervix, or had delivered, whereas 35.4% of catheter group had still unripe cervix (x2 = 29.856, P = 0.0001). Misoprostol group was less likely to require oxytocin infusion (x2 = 52.600, P = 0.0001) and less likely to require cesarean delivery (cesarean: misoprostol versus catheter: 11% versus 34% (x2 = 9.800, P = 0.001)). Total medical cost for misoprostol was less than that of catheter (x2 = 14.703, P = 0.0001). Conclusion: 50 μg vaginal misoprostol, compared with catheter placement, was more effective, cheaper, and safe as a procedure of cervical ripening before induction of labor.

To investigate the role of abnormal cerebroplacental ratio (CPR) in predicting adverse fetal outcome in pregnancies with induction of labor.This prospective observational study conducted at Medeniyet University Göztepe Training and Research Hospital between December 1, 2018 and October 31, 2019 enrolled women with scheduled induction of labor at or beyond 37 weeks of pregnancy. Women with singleton non-anomalous fetuses with cephalic presentation and who had Bishop scores of 5 or less in pelvic examination were included in the study. Exclusion criteria were the presence of uterine scar history, non-cephalic presentation, multiple pregnancy, vacuum- or forceps-assisted delivery, and shoulder dystocia. Using fetal Doppler ultrasound, CPR was calculated (the ratio of umbilical artery to middle cerebral artery pulsatility index) and categorized into abnormal CPR (1) and normal CPR (≥1). Data on maternal and delivery characteristics, fetal birth weight, and fetal complications were compared between the groups.A total of 145 women were included, 28 in the abnormal CPR group and 117 in the normal CPR group. Multivariate analysis revealed labor induction at a later week of pregnancy (odds ratio [OR] 10.33, P = 0.001), lack of intrauterine growth restriction (IUGR) (OR 13.21, P = 0.001), fetal distress (OR 8.14, P = 0.003) or meconium aspiration (OR 159.91, P = 0.001), and umbilical artery pH values greater than 7.31 (OR 17.51, P = 0.015) to be associated with an increased likelihood of having normal (≥1) CPR values. Receiver operating characteristic analysis revealed association of normal CPR values with later labor induction (cut-off value of38.3 weeks, P = 0.001), higher birth weight (cut-off value of2460 g, P = 0.022) and higher umbilical artery pH (cut-off value of7.31, P = 0.007).Our findings revealed the significant role of abnormal CPR in predicting adverse fetal outcome in singleton pregnancies with scheduled induction of labor.

Objective. The aim is to evaluate the influence of obesity on labor induction and outcomes. Methods. The case-control study was carried out retrospectively using the data from the Department of Obstetrics and Gynaecology of the LithuanianUniversity ofHealth Sciences Birth Registry from 2018.We analyzedmaternity and medical history records of 509 women who had induction of labor: 114 were obese and 395 had normal weight. Patients demographics, methods and indications of induction of labor, complications of pregnancy, delivery mode, labor length and neonatal characteristics including birthweight and Apgar score were analyzed. Results. Gestational diabetes was diagnosed in 51.8% of obese and in 17.5% normal weight women (P

Introduction: Post-term pregnancy is one that extends to or beyond 42 weeks of gestation, Patients at 40 weeks can either undergo induction or can be managed expectantly. At 41weeks of gestation the perinatal mortality rate is 9 per 1000 live births, and it continues to rise thereafter. Labour induction at 41 weeks gestation for otherwise uncomplicated singleton pregnancies reduces caesarean delivery rates without compromising perinatal outcomes. Study Design: 200 Low risk primigravida at 40 weeks of gestation were included and randomized into two groups. Group I=Induction group (n=100) Patients were admitted at 40 weeks and were induced at 40+0 to 40+6 Weeks. Patients in Group II the Expectant group which was further subdivided into 2 groups. Group IIa=Those who went into labour or had PROM or any omnious event during the Expectant period till 41weeks. Group IIb=Patients who reached 41weeks and then were induced. Results: Expectant management till 41weeks and then inducing labour at 41weeks resulted in a significantly higher number of patients having vaginal delivery when compared with patients who were induced at 40weeks. The incidence of meconium stained liquor, caesarean section, non-reassuring CTG, maternal complications and neonatal morbidity was high in Group I when compared to Group II. Conclusion: Labour induction in uncomplicated pregnancies at 41 weeks is not associated with increased rates of operative delivery, maternal and neonatal morbidity. Keywords: Expectant management, Labor induction, Post term pregnancy.

Introduction: Premature rupture of the membranes at term is spontaneous rupture of the membranes after 37 wks of the gestations and before the onset of the regular painful uterine contractions. It occurs in ten percent of cases and managed either expectantly or actively. Objective: The present research was undertaken to study the effectiveness of early labor induction and to assess maternal and fetal outcome in term pregnancy with cervical PGE2 versus expectant management. Materials and Methods: This was a randomised control trial conducted in the Department of Obstetrics and Gynaecology from October 2014 to September 2016 on a sample size of 144. They were divided into two groups – Group A containing subjects with expectant management and Group B with subjects who were induced with intracervical PGE2 and their outcome was compared. Results: In group A, 70.83% of cases spontaneous labours started within 24 hrs and in those with induction 56.94% were successful. Of the spontaneously delivered 65.28% were primi with 58.33% having favourable Bishop Score. In those with induction 73.61% were primi with 56.94% having favourable Bishop Score. Conclusion: Early induction of labour in cases of PROM at term with PGE-2 GEL resulted in reduction of latency of labour but also increased operative intervention. Expectant line has greater maternal and neonatal morbidity. Keywords: Amniotic fluid, Expectant management, Intracervical PGE2, Premature rupture of membrane, Term pregnancy.

Objective To compare the peripartum outcomes when labor is induced with prostaglandins E1 versus E2. Methodology The Consortium of Safe Labor database was utilized. Women with non-anomalous singletons >24 weeks gestation undergoing induction were analyzed. The primary endpoint was a composite adverse maternal outcome with a composite adverse neonatal outcome as our secondary outcome. Results Of the 228,438 births within the database, 8229 (10.8%) met inclusion criteria with 4703 (55.7%) receiving PGE1, and 3741 (44.3%), PGE2. The rate of vaginal delivery was similar between both. Composite adverse maternal outcome, was more likely among the prostaglandin E1: 7.2% vs. 1.5% (aOR 4.20; 95% CI 3.02-5.85); similar trend observed with composite adverse neonatal outcome rates: 4.6% vs. 1.4% (aOR 1.69; 95% CI 1.14-2.50). Conclusion Utilization of prostaglandin E1, compared to E2, was associated with an increased likelihood of adverse maternal and neonatal outcomes.

Preterm labor and birth are the primary causes of neonatal morbidities and mortalities. The early detection and treatment of preterm uterine muscular contraction are crucial for the management of preterm labor. In this work, a ring electrode with a wireless electrical recording and stimulating (RE-WERS) system was designed, fabricated, and investigated for the non-invasive monitoring of uterine contraction/relaxation as a diagnostic and therapeutic tool for preterm labor. By using an organ bath system, we confirmed that the uterine contraction force in mice can be decreased by the application of electrical stimulation. Then, the RE-WERS system was inserted non-invasively through the vagina to the cervix of a pregnant minipig, and it successfully recorded the uterine contraction and reflect signals when various electrical stimulating conditions were applied. The difference in the uterine signals before and after the injection of a labor induction drug, such as oxytocin and prostaglandin $\text{F}2\alpha $ , was recorded, and the difference was remarkable. In addition, the uterine signal that was recorded was well matched with the signal of the electromyography (EMG) kit during open abdominal surgery. It seemed that the continuous and various electrical stimulations affected the delay or inhibition of childbirth in the pregnant minipig.