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Objective Methods Results Conclusion Registration at Clinical Trials To examine whether cervical ripening with a double balloon device for 6 h is as effective as 12 h in patients with a cervical length ≥ 30 mm measured on transvaginal ultrasound before induction of labor, and to determine whether patients with a long cervix need to have the balloon placed for a longer time.This is a secondary analysis of data from a randomized controlled trial that compared maternal and neonatal outcomes between women undergoing cervical ripening with a double balloon device for 6 h (study group) versus 12 h (control group). In this secondary analysis, we included only patients who had cervical length ≥ 30 mm measured on transvaginal ultrasound on admission. Our primary outcome was a Bishop score change after removal of the device. Secondary outcomes included insertion to delivery interval, mode of delivery, and oxytocin infusion duration.Sixty‐seven women met the inclusion criteria and were included in the analysis: 33 in the 6‐h group and 34 in the 12‐h group. Maternal characteristics were similar between both groups. Bishop score difference between the preinsertion and the postremoval scores were similar in the two groups (2.67 ± 1.8 vs. 2.53 ± 1.69, P = 0.76), while insertion to delivery time was 10 h shorter in the 6‐h group (20.95 vs. 31.21, P = 0.02; mean difference, −10.26 [95% CI, −19.0 to −1.51]). The other secondary outcomes remained similar in both groups.In women undergoing induction of labor who have a cervical length ≥ 30 mm measured on admission transvaginal ultrasound, removing a double balloon device after 6 h achieved similar Bishop score changes as removal after 12 h, but significantly reduced the time to delivery.https://classic.clinicaltrials.gov/ct2/show/NCT03045939. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to evaluate low‐dose oral misoprostol induction, and compare different methods used in second‐line induction in patients with a Bishop score less than 6. Methods: This retrospective study analyzed the medical history and courses of pregnancy of all patients induced with first‐line of low‐dose oral misoprostol (50 μg every 4 h with a total of 200 μg/24 h) from April 2021 to June 2022 in a university hospital center, and reported outcomes according to the second‐line method of induction. Results: Among 437 labor inductions with low‐dose oral misoprostol, 120 patients required a second‐line induction. Predictive factors of first‐line failure were higher body mass index (P = 0.011), absence of premature rupture of membranes (P = 0.021) and earlier term of pregnancy (P < 0.001). Regarding second methods of induction of labor, time from induction to delivery was shorter in the oxytocin group than the dinoprostone and misoprostol groups (24.0 vs. 41 and 51.0 h, respectively; P < 0.001), and was also significantly shorter in the dinoprostone than the misoprostol group (P = 0.048). Cesarean section rates did not differ between the three groups (P = 0.651). There were no clinically significant differences in adverse events between the groups. Conclusion: Normal body mass index, previous rupture of membranes and later term of induction of labor were the three favoring success factors during first‐line oral misoprostol. In cases of a Bishop score <6, oxytocin may be the best option to reduce duration to delivery, with the same maternal‐fetal outcomes, including a similar rate of vaginal delivery. Synopsis: If a Bishop score was <6 after 24 h oral misoprostol, oxytocin could be the best method to reduce duration to delivery. [ABSTRACT FROM AUTHOR]

Objective: Recently, two randomized controlled trials compared removal of cervical ripening balloon (CRB) after 6 versus 12 h. Their results showed similar Bishop score changes in both groups and a shorter time to delivery in the 6‐h group. Neither of the studies was powered to show difference in mode of delivery. The aim of this study was to compare mode of delivery when the CRB was removed after 6 versus 12 h. Methods: A historical control study comparing induction of labor with a CRB between two time periods, one in which the CRB was removed after 12 h (12‐h group), and the other in which it was removed after 6 h (6‐h group). We included term pregnancies with a singleton fetus in vertex presentation. We excluded patients with a previous cesarean delivery, failed ripening with prostaglandins prior to CRB insertion, and any contraindication for vaginal delivery. The primary outcome was mode of delivery. Secondary outcomes included delivery within 24 h and other maternal and neonatal outcomes. Results: We included 1704 patients, 914 in the 12‐h group, and 717 in the 6‐h group. Removal after 6 h was associated with a lower rate of cesarean and instrumental deliveries (28.6% vs 22.5%, and 12% vs 6.2%, respectively) and a higher rate of vaginal delivery within 24 h. All differences were statistically significant. Conclusion: Removing a cervical ripening balloon after 6 rather than 12 h is associated with reduced cesarean and instrumental delivery rates, and should be considered as a reasonable, and potentially superior alternative in labor induction protocols with intracervical ripening balloon. Synopsis: Removal of cervical ripening balloon after 6 versus 12 h was associated with lower cesarean delivery rates and higher vaginal delivery rates within 24 h. [ABSTRACT FROM AUTHOR]

Abstract Background Previous studies had found that the mechanical methods were as effective as pharmacological methods in achieving vaginal delivery. However, whether balloon catheter induction is suitable for women with severe cervical immaturity and whether it will increase the related risks still need to be further explored. Research aim To evaluate the efficacy and safety of Foley catheter balloon for labor induction at term in primiparas with different cervical scores. Methods A total of 688 primiparas who received cervical ripening with a Foley catheter balloon were recruited in this study. They were divided into 2 groups: Group 1 (Bishop score ≤ 3) and Group 2 (3

Background: Induction of labor (IOL) in nulliparas with premature rupture of membranes (PROM) and an unfavorable cervix at term poses challenges. Our study sought to investigate the impact of prostaglandin E2 (PGE2) compared to oxytocin on the duration of IOL in this specific group of parturients. Methods: This was retrospective matched-case study. All nulliparas with term PROM who underwent induction between January 2006 to April 2023 at Shaare Zedek Medical Center were identified. Cases induced by either PGE2 or oxytocin were matched by the following criteria: (1) time from PROM to IOL; (2) modified Bishop score prior to IOL ≤ 5; (3) newborn birthweight; and (4) vertex position. The primary outcome was time from IOL to delivery. Results: Ninety-five matched cases were identified. All had a modified Bishop score ≤ 5. Maternal age (26 ± 4.7 years old, p = 0.203) and gestational age at delivery (38.6 ± 0.6, p = 0.701) were similar between the groups. Matched factors including time from PROM to IOL (23.5 ± 19.2 versus 24.3 ± 21.4 p = 0.780), birth weight of the newborn (3111 g versus 3101 g, p = 0.842), and occiput anterior position (present on 98% in both groups p = 0.687) were similar. Time from IOL to delivery was significantly shorter by 3 h and 36 min in the group induced with oxytocin than in the group induced with PGE2 (p = 0.025). Within 24 h, 55 (58%) of those induced with PGE2 delivered, compared to 72 (76%) of those induced with oxytocin, (p = 0.033). The cesarean delivery rates [18 (19%) versus 17 (18%)], blood transfusion rates [2 (2%) versus 3 (3%)], and Apgar scores (8.8 versus 8.9) were similar between the groups (PGE2 versus oxytocin, respectively), p ≥ 0.387. Conclusions: Induction with oxytocin, among nulliparas with term PROM and an unfavorable cervix, was associated with a shorter time from IOL to delivery and a higher rate of vaginal delivery within 24 h, with no difference in short-term maternal or neonatal adverse outcomes. [ABSTRACT FROM AUTHOR]

Background: Previous studies had found that the mechanical methods were as effective as pharmacological methods in achieving vaginal delivery. However, whether balloon catheter induction is suitable for women with severe cervical immaturity and whether it will increase the related risks still need to be further explored. Research aim: To evaluate the efficacy and safety of Foley catheter balloon for labor induction at term in primiparas with different cervical scores. Methods: A total of 688 primiparas who received cervical ripening with a Foley catheter balloon were recruited in this study. They were divided into 2 groups: Group 1 (Bishop score ≤ 3) and Group 2 (3 < Bishop score < 7). Detailed medical data before and after using of balloon were faithfully recorded. Results: The cervical Bishop scores of the two groups after catheter placement were all significantly higher than those before (Group 1: 5.49 ± 1.31 VS 2.83 ± 0.39, P<0.05; Group 2: 6.09 ± 1.00 VS 4.45 ± 0.59, P<0.05). The success rate of labor induction in group 2 was higher than that in group 1 (P<0.05). The incidence of intrauterine infection in Group 1 was higher than that in Group 2 (18.3% VS 11.3%, P<0.05). Conclusion: The success rates of induction of labor by Foley catheter balloon were different in primiparas with different cervical conditions, the failure rate of induction of labor and the incidence of intrauterine infection were higher in primiparas with severe cervical immaturity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Using a COOK® Cervical Ripening Balloon (CCRB) for cervical maturity has become a common clinical practice for the induction of labour (IOL). OBJECTIVE: To develop and validate a predictive instrument that could estimate the risk of a caesarean after IOL in term pregnancies with CCRB treatment. METHODS: The medical records of 415 pregnant women requiring IOL from January 2018 to October 2022 were retrospectively reviewed and randomly selected for training (290) and validation (125) sets in a 7:3 ratio. A model for predicting the risk of a caesarean was virtualised by a nomogram using logistic regression analysis. RESULTS: After completing the multivariate analysis, parity (odds ratio [OR] = 0.226; p = 0.017), modified Bishop score at induction (OR = 0.688; p = 0.005) and the artificial rupture of membranes (OR = 0.436; p = 0.010) were identified as the predictors for implementing a caesarean delivery after IOL. The decision curve analysis showed that the model achieved a net benefit across all threshold probabilities. CONCLUSION: We successfully constructed a nomogram for caesarean delivery after IOL in pregnancies with CCRB treatment using factors including parity, modified Bishop score at induction and the artificial rupture of membrane. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to compare the evaluation of cervical length measured by the Bishop score and transvaginal ultrasonography in determining the need for prostaglandin application for cervical ripening in term nulliparous pregnancies. Material and methods: In our study, a total of 120 patients who were admitted to our hospital between February 2015 and August 2015 were divided into two groups as cervical length group and Bishop score group according to hospitalization order by applying the Permuted Block Randomization method, which is one of the Restricted Randomization methods. Each patient included in the study was evaluated with both the Bishop score and transvaginal ultrasonography. Groups were compared according to the APGAR scores in the 1st and 5th minutes, transition within 12 hours, birthing within 24 hours, birthing with only dinoprostone, birthing with only oxytocin, duration of administration of dinoprostone, duration of oxytocin administration, type of birth, rate of cesarean section, and need for neonatal intensive care. Results: While cervical ripening with dinoprostone was applied to 28 (46.7%) of 60 pregnant women in the Bishop group, labor induction with oxytocin was applied to the remaining 32 (53.3%) pregnant women. In the cervical length group, these values were 33 (55.0%) and 27 (45.0%), respectively. There was no statistically significant difference between study groups in terms of the need for dinoprostone for cervical ripening (p = 0.361). Of those with a Bishop score of 4 or below, 78.6% (n = 22) had a cervical length of over 28 mm, and 71.4% (n = 20) needed oxytocin. Of those with a Bishop score above 4, none of them had a cervical length greater than 28 mm. A statistically significant difference was found between those with a Bishop score of 4 or below and those above 4 in terms of cervical length (p < 0.05). Among those with a Bishop score of 4 or below, the percentage of those with a cervical length above 28 mm was significantly higher than that of those with a Bishop score above 4. Conclusions: In our study, the delivery time of those with a cervical length of 28 mm and above was significantly higher than those with a cervical length of less than 28 mm, while the bishop score was significantly lower. In order to develop a more objective method that can replace the Bishop scoring system in determining the need for cervical ripening before labor induction, prospective randomized studies that screen larger numbers of patients are needed. [ABSTRACT FROM AUTHOR]

Background: Induction fails in about 20% of induced pregnancies and has no universally accepted definition. Failed induction is the failure to establish labor or inability to achieve the active stage of labor, considering the definition of induction of labor (IOL). It needs to be differentiated from the failure of progress of labor. There is no evidence to recommend treatment for failed induction, but usually, delivery by cesarean section will be required. Aims and Objectives: The study was designed to start induction for an indication that justifies operative delivery in cases of failure. Materials and Methods: A prospective observational study was done over a period of 1 year among antenatal women confirmed to be at term with cephalic presentation in the absence of active labor with unscarred uterus. Results: The incidence of IOL was found to be 25.97% and failure was observed in 50 (21.83%) of those included in the study. Among those with failure, failed pre-induction ripening was seen in 26 (11.3%) and failed induction in 24 (10.4%). Although many variables were found to be associated with the outcome of labor, a statistically significant association was observed with premature rupture of membranes, pre-induction Bishop score, and birth weight of the baby. Conclusion: The study helps in better clinical judgment of patients who will have a successful induction or a failed induction and the patients could be counseled accordingly. This judgment will also help to avoid unnecessary inductions in those who have the risk factors for failed induction unless the induction is absolutely necessary.

Objective: To analyze the predictive value of cervical Bishop score combined with cervical ultrasound elastography and serological markers for cervical ripening. Methods: 178 pregnant women who were registered at Peking University Third Hospital from January 2022 to June 2022 and underwent induced labor were selected and divided into a successful labor induction group of 158 cases and a failed labor induction group of 20 cases. Cervical ultrasound elastography indexes, serological markers (relaxin, estradiol, estriol, progesterone), cervical Bishop score before induction of labor were collected and analyzed. Compare the differences in the above indicators between two groups, and use the receiver operator characteristic curve (ROC curve) to analyze the value of combined detection in evaluating cervical ripening. Results: The elastic contrast index (ECI), external cervical os (EOS) and relaxin levels of the failed labor induction group were lower than in the successful labor induction group, and the cervical length was longer than that in the successful labor induction group (P＜0.05). There was no significant difference in the levels of progesterone, estradiol and estriol between the two groups (P＞0.05). The combination of cervical Bishop score, ultrasound elastography indicators (ECI, EOS, cervical length), and serum relaxin had the highest evaluation value for cervical ripening, with an area under the ROC curve of 0.940. Conclusions: The cervical Bishop score combined with cervical ultrasound elastography and relaxin can improve the accuracy of predicting cervical ripening. [ABSTRACT FROM AUTHOR]

Background: Induction fails in about 20% of induced pregnancies and has no universally accepted definition. Failed induction is the failure to establish labor or inability to achieve the active stage of labor, considering the definition of induction of labor (IOL). It needs to be differentiated from the failure of progress of labor. There is no evidence to recommend treatment for failed induction, but usually, delivery by cesarean section will be required. Aims and Objectives: The study was designed to start induction for an indication that justifies operative delivery in cases of failure. Materials and Methods: A prospective observational study was done over a period of 1 year among antenatal women confirmed to be at term with cephalic presentation in the absence of active labor with unscarred uterus. Results: The incidence of IOL was found to be 25.97% and failure was observed in 50 (21.83%) of those included in the study. Among those with failure, failed pre-induction ripening was seen in 26 (11.3%) and failed induction in 24 (10.4%). Although many variables were found to be associated with the outcome of labor, a statistically significant association was observed with premature rupture of membranes, pre-induction Bishop score, and birth weight of the baby. Conclusion: The study helps in better clinical judgment of patients who will have a successful induction or a failed induction and the patients could be counseled accordingly. This judgment will also help to avoid unnecessary inductions in those who have the risk factors for failed induction unless the induction is absolutely necessary. [ABSTRACT FROM AUTHOR]

Objective: To compare pre and post Foley’s catheter Bishop Score during labour induction. Methods: This study was a retrospective study conducted at the Aga Khan University Hospital Karachi, Pakistan after approval from ethical review board. All women who underwent induction of labour with Foley’s Catheter at gestation of 37 weeks or more from September 2014-October 2015 were included. Data was entered and analyzed in Statistical Package for Social Sciences (SPSS) version 19.0. The comparison between pre and post Foley’s catheter Bishop Score during labour induction will be calculated by Wilcoxon sign test. Results: There were 981 cases of inductions of labour, 749 (76.3%) received Foley’s catheter, in combination with prostaglandins and oxytocin. About 68% were vaginal deliveries while 32% underwent C-section. Two third of women had bishop <4. Overall, Bishop score improved significantly in all patients with the catheter however, maximum benefit was seen in patients where the catheter was placed for 10-12 hours. Conclusion: Foley’s is the better and safer option. In view of our results, It has been recommended to keep the Foley’s for 10-12 hours to get significant improvement in bishop score. [ABSTRACT FROM AUTHOR]

The purpose of this prospective cohort study is to identify the predictive factors for vaginal delivery among women (n = 146) who underwent cervical ripening using a dinoprostone insert (PG) alone (13.7%), cervical ripening balloon (CRB) alone (52.7%), oral misoprostol (M) alone (4.1%), or repeated methods (R, 29.5%) for gestational diabetes mellitus (GDM) at term, and to analyze maternal and neonatal morbidity outcomes according to the method for cervical ripening. After cervical ripening, vaginal delivery occurred in 84.2% (n = 123) and was similar among groups (90.0% after PG, 83.1% after CRB, 83.3% after M, and 83.7% after R; p = 0.89). After a multivariable logistic regression analysis adjusted for potential confounders, the internal cervical os being open before cervical ripening was a predictor of vaginal delivery (adjusted odds ratio (OR) of 4.38, 95% confidence index (CI) of 1.62–13.3, p = 0.03), and previous cesarean delivery was a predictor of cesarean delivery (aOR of 7.67, 95% CI of 2.49–24.00, p < 0.01). Birthweight was also significantly associated with cesarean delivery (aOR of 1.15, 95% CI of 1.03–1.31, p = 0.02). The rates of maternal and neonatal morbidity outcomes were 10.9% (n = 16) and 19.9% (n = 29), respectively, and did not differ according to the mode of delivery and to the method used for cervical ripening. Identifying these specific high-risk women (previous cesarean delivery and internal cervical os being closed before cervical ripening) for cesarean delivery among women who underwent cervical ripening for GDM at term is important and practical for all physicians to make a decision in partnership with women. [ABSTRACT FROM AUTHOR]

We evaluated quantitative cervicovaginal foetal-fibronectin as a predictor of cervical ripening and labour duration in late-term pregnant women with an unfavourable cervix. This was an analytical cross-sectional study wherein 152 women, with late-term pregnancy and unfavourable cervix, at 41weeks3days gestational age, had pre-induction quantitative cervicovaginal foetal-fibronectin determined using ELISA. Data were compared in nulliparas and multiparas at a significance level < 0.05. The mean age of late-term pregnant women was 30.4 ± 4.3 years. Median cervicovaginal foetal-fibronectin levels in nulliparous and multiparous women were 45.35 ng/ml and 46.93 ng/ml respectively(p = 0.289). The correlation between foetal-fibronectin levels and cervical ripening duration was poor in nulliparous(r = 0.014) and multiparous(r = 0.024) women. The Youden's foetal-fibronectin cut-off level had a sensitivity of 53.5% and specificity of 71.6% in predicting cervical ripening duration of > 12 hours in late-term pregnancy with an area under the ROC curve of 0.634. Quantitative cervicovaginal foetal-fibronectin is a poor correlate and predictor of cervical ripening and induced labour duration in late-term pregnancy. What is already known on this subject? Cervicovaginal foetal fibronectin is useful in the prediction of preterm delivery but its role in prolonged pregnancy is unclear. What the results of this study add? Cervicovaginal foetal fibronectin is a poor correlate and predictor of cervical ripening and induced labour duration in late-term pregnancy What the implications are of these findings for clinical practice and/or further research? Cervicovaginal fibronectin should not be used to predict ease and success of cervical ripening and induction of labour in women with late-term pregnancy. [ABSTRACT FROM AUTHOR]

Abstract Background To evaluate the improvement of evaluation accuracy of cervical maturity for Chinese women with labor induction by adding objective ultrasound data and machine learning models to the existing traditional Bishop method. Methods The machine learning model was trained and tested using 101 sets of data from pregnant women who were examined and had their delivery in Peking University Third Hospital in between December 2019 and January 2021. The inputs of the model included cervical length, Bishop score, angle, age, induced labor time, measurement time (MT), measurement time to induced labor time (MTILT), method of induced labor, and primiparity/multiparity. The output of the model is the predicted time from induced labor to labor. Our experiments analyzed the effectiveness of three machine learning models: XGBoost, CatBoost and RF(Random forest). we consider the root-mean-squared error (RMSE) and the mean absolute error (MAE) as the criterion to evaluate the accuracy of the model. Difference was compared using t-test on RMSE between the machine learning model and the traditional Bishop score. Results The mean absolute error of the prediction result of Bishop scoring method was 19.45 h, and the RMSE was 24.56 h. The prediction error of machine learning model was lower than the Bishop score method. Among the three machine learning models, the MAE of the model with the best prediction effect was 13.49 h and the RMSE was 16.98 h. After selection of feature the prediction accuracy of the XGBoost and RF was slightly improved. After feature selection and artificially removing the Bishop score, the prediction accuracy of the three models decreased slightly. The best model was XGBoost (p = 0.0017). The p-value of the other two models was

HIGHLIGHTS • Oral misoprostol is more effective than vaginal misoprostol in cervical ripening as a part of induction of labor. • Oral misoprostol is as safe as vaginal misoprostol. ABSTRACT Objective: To compare Bishop score changes and labor event between oral and vaginal misoprostol in pregnancy beyond 41 weeks. Materials and Methods: A total of 52 pregnant women with more than 41 weeks of gestation, had a Bishop score less than 5, and were undergoing induction labor were randomly divided into two groups: oral and vaginal misoprostol. In the oral misoprostol group, participants were given 25 mg of misoprostol in a solution with a concentration of 1 ug/ml every 2 hours. In the vaginal misoprostol group, a 25 mg misoprostol tablet was inserted into the posterior fornix every 6 hours. The two groups were compared in terms of Bishop score during the first 6 hours, changes in Bishop score, labor at term events, neonatal outcomes, complications, and side effects after the administration of misoprostol. Results: The oral group showed significantly higher changes in Bishop score compared to the vaginal group (5.5 vs 3.6; p=0.0001). The median interval times for induction of labor at term, induction at stage II, and induction at birth were found to be shorter in the oral misoprostol group compared to the vaginal group (7.3 hours vs 10.6 hours, 14.0 hours vs 16.8 hours, and 14.6 hours vs 17.6 hours; p=0.002, 0.003, 0.002). Labor at term occurred much more frequently in the oral group (53.8% vs 15.4%). Additionally, the oral misoprostol group had a 3.5 times higher likelihood of experiencing labor at term within the first 6 hours after the initial administration compared to the vaginal group (OR 3.5, 95% CI 1.33-9.23). Conclusion: Oral administration of misoprostol for cervical ripening has been demonstrated to be more effective than vaginal administration, greater bishop score changes while maintaining an equivalent level of safety.

Background and Aim :One of the methods of preparing the cervix for induction of labor is use of drugs. Use of prostaglandins and estradiol is one of these methods. The aim of this study was to compare the effects of estradiol and misoprostol on cervical preparation. Materials and Methods: This study included 100 pregnant women with Bishop score of less than four who had referred for normal delivery. The participants assigned to groups of misoprostol suppository and estradiol cream by random method. The women were examined every two hours and cervical Bishop score and labor progress were assessed. If uterine contractions were not suitable after 6 hours, induction with oxytocin was performed by the conventional method. Finally, two groups were compared in relation to Bishop score, onset of uterine contractions, lengths of labor stages, rate of cesarean section, and maternal and fetal complications by use of SPSS22 software. p 0.05) Conclusion: Estradiol cream can be used to prepare the cervix for childbirth. Use of this method, can reduce the duration of the first stage of labor without any complications for mothers and babies. This method can reduce the rate of cesarean section and result in better health of the mothers and babies.

We evaluated quantitative cervicovaginal foetal-fibronectin as a predictor of cervical ripening and labour duration in late-term pregnant women with an unfavourable cervix. This was an analytical cross-sectional study wherein 152 women, with late-term pregnancy and unfavourable cervix, at 41weeks3days gestational age, had pre-induction quantitative cervicovaginal foetal-fibronectin determined using ELISA. Data were compared in nulliparas and multiparas at a significance level < 0.05. The mean age of late-term pregnant women was 30.4 ± 4.3 years. Median cervicovaginal foetal-fibronectin levels in nulliparous and multiparous women were 45.35 ng/ml and 46.93 ng/ml respectively(p = 0.289). The correlation between foetal-fibronectin levels and cervical ripening duration was poor in nulliparous(r = 0.014) and multiparous(r = 0.024) women. The Youden’s foetal-fibronectin cut-off level had a sensitivity of 53.5% and specificity of 71.6% in predicting cervical ripening duration of > 12 hours in late-term pregnancy with an area under the ROC curve of 0.634. Quantitative cervicovaginal foetal-fibronectin is a poor correlate and predictor of cervical ripening and induced labour duration in late-term pregnancy.IMPACT STATEMENT What is already known on this subject? Cervicovaginal foetal fibronectin is useful in the prediction of preterm delivery but its role in prolonged pregnancy is unclear. What the results of this study add? Cervicovaginal foetal fibronectin is a poor correlate and predictor of cervical ripening and induced labour duration in late-term pregnancy What the implications are of these findings for clinical practice and/or further research? Cervicovaginal fibronectin should not be used to predict ease and success of cervical ripening and induction of labour in women with late-term pregnancy.

Background: To evaluate the improvement of evaluation accuracy of cervical maturity for Chinese women with labor induction by adding objective ultrasound data and machine learning models to the existing traditional Bishop method. Methods: The machine learning model was trained and tested using 101 sets of data from pregnant women who were examined and had their delivery in Peking University Third Hospital in between December 2019 and January 2021. The inputs of the model included cervical length, Bishop score, angle, age, induced labor time, measurement time (MT), measurement time to induced labor time (MTILT), method of induced labor, and primiparity/multiparity. The output of the model is the predicted time from induced labor to labor. Our experiments analyzed the effectiveness of three machine learning models: XGBoost, CatBoost and RF(Random forest). we consider the root-mean-squared error (RMSE) and the mean absolute error (MAE) as the criterion to evaluate the accuracy of the model. Difference was compared using t-test on RMSE between the machine learning model and the traditional Bishop score. Results: The mean absolute error of the prediction result of Bishop scoring method was 19.45 h, and the RMSE was 24.56 h. The prediction error of machine learning model was lower than the Bishop score method. Among the three machine learning models, the MAE of the model with the best prediction effect was 13.49 h and the RMSE was 16.98 h. After selection of feature the prediction accuracy of the XGBoost and RF was slightly improved. After feature selection and artificially removing the Bishop score, the prediction accuracy of the three models decreased slightly. The best model was XGBoost (p = 0.0017). The p-value of the other two models was < 0.01. Conclusion: In the evaluation of cervical maturity, the results of machine learning method are more objective and significantly accurate compared with the traditional Bishop scoring method. The machine learning method is a better predictor of cervical maturity than the traditional Bishop method. [ABSTRACT FROM AUTHOR]

Background: Induction of labour (IOL) is a way to stimulate the onset of labour using mechanical and pharmacological methods. IOL is one of the most frequently performed obstetric procedures worldwide. We aimed to determine compliance with guidelines and to investigate factors associated with the success of labour. Methods: In this retrospective, observational study, we analysed all induced deliveries in a Swiss hospital between January 2020 and December 2022. Results: Out of 1705 deliveries, 349 women underwent IOL, and 278 were included in this study, with an average age of 32 years (range 19–44 years). Most of the women were induced for missed deadlines (20.1%), the premature rupture of membranes (16.5%), and gestational diabetes mellitus (9.3%), and there was a good adherence to the guideline, especially with the indication and IOL monitoring (100%). However, an improvement needs to be made in measuring and documenting the Bishop score (41%). The success of labour was associated with multiparity (81.8% vs. 62.4% p = 0.001) and maternal non-obesity (73.4 vs. 54.1% p = 0.026). Conclusions: An improvement is needed in the measurement and documentation of the Bishop score. Further research is needed to confirm the found associations between parity, obesity, and the success of IOL. [ABSTRACT FROM AUTHOR]

Background: Prostaglandin E2 in different forms has been widely used for induction of labor in women with an unfavorable cervix. No significant differences have been noticed between prostaglandin E2 tablets versus gel for induction. The aim of this study was to compare vaginal prostaglandin E2 tablet of 3mg with an increased dose of gel i.e 2mg given both to primigravidas, multigravidas as well as grand multigravidas, regarding any differences in mode of delivery, induction delivery interval and any adverse maternal and fetal outcomes. Materials & Methods: A randomized control trial was conducted at the department of Gynecology and Obstetrics of Qazi Hussain Ahmad medical complex over 6-month period from July to December 2021. One hundred and seventy-nine women, who met the inclusion and exclusion criteria, were randomly divided into two groups. Patients in group A were induced with Prostaglandin E2 tablet of 3mg and those in group B received vaginal gel of 2mg. Drug was kept in posterior fornix of vagina at 6 hourly intervals with pre and post induction CTG and fetal heart rate recorded. A maximum of 2 doses of each formulation was given. Primary outcome measures were mode of delivery and induction delivery interval. Secondary outcome includes adverse maternal and fetal outcomes, in terms of postpartum hemorrhage, uterine hyper stimulation and fetal distress. A structured questionnaire was used to collect the relevant information of the patient. After data collection and analysis by using MS Office & SPSS 20, the results were finally presented in tables & figures. Results: One hundred and seventy-nine women were randomly divided into two groups. Among both groups, no difference was found between modes of delivery i.e. normal vaginal deliveries and c section with increasing parity. Also it was found that parity has no significant impact with respect to the number of doses required of each formulation for inducing labor and modes of delivery with a P-value (0.136 & 0.583) and (0.421 & 0.123) between single and double dose of tablet and gel and among the patients delivered by NVD and C-section respectively. However, a statistically significant difference was found in induction delivery interval with a p-value of 0.02 &0.001 respectively between parity and time duration (=12hrs & >12hrs). A consistent result was found between both formulations for adverse maternal and fetal outcomes in terms of fetal distress, postpartum hemorrhage and uterine hyper stimulation respectively. Conclusion: We have concluded that Primi and multi gravidas are more likely to have a shorter induction delivery interval i.e. = 12 hours in the group A versus the group B while grand multigravidas are more likely to have a shorter induction delivery interval with the gel. However, no significant differences in the number of doses, mode of delivery and adverse maternal and fetal outcomes was found between the two groups. [ABSTRACT FROM AUTHOR]

Objective: To determine Maternal and Fetal outcome in women undergoing induction of labour with low dose misoprostol. Method: A cross-sectional study was carried out to determine the efficacy of Misoprostol for induction of labor (IOL) in MTI, Lady Reading Hospital (LRH), Peshawar from 21st January to 31st December 2021. All pregnant women with singleton pregnancy and cephalic presentation admitted for Induction of Labor were included in the study. Maternal and Fetal outcome was noted. Induction of labor was started with 25 micrograms of Misoprostol, repeated every six hours depending on Bishop Score. Results: Three hundred and thirty-seven women were included in this study. The majority of females (76%) were in 18-35 years age group. In 92.3% of females, the Bishop score was less than six. The maximum number of females (33.5%) delivered after eight hours of IOL. Sixty-six (66.46%) of females had gestational age of 37-40 weeks. Premature rupture of membranes was the most common indication (32.9%). Three doses of misoprostol were required in 31.2% of females. Only 5.6% of females required six doses of misoprostol for induction. With Misoprostol 85.1% of females delivered spontaneously, 2.37% required forceps delivery, 1.7% required vacuum delivery, and 10.68% delivered by Caesarean Section. APGAR score was 8 /10 in 84% of neonates at birth. Eighty-seven %(87.8%) of neonates did not require NICU admission. Conclusion: Misoprostol is a safe medicine to be used to induce labor in females. It can help shorten the duration of labor, with good fetomaternal outcome. KEYWORDS: Apgar score, Bishop Score, Eclampsia, Induction of Labor (IOL), Misoprostol. [ABSTRACT FROM AUTHOR]

Objective: To compare the values of transvaginal ultrasound (TVU) and Bishop score (BS) for predicting outcomes of induction of labor (IOL). Methods: The BS and TVU were assessed before IOL. TVU parameters included cervical length (CL) and E‐Cervix comprising the cervical hard ratio (HR) and the mean strain level of internal os (IOS). Study end‐points included the duration of the latent phase within 15 or 18 h and delivery within 24 h. Results: In multivariable logistic regression models, at the first two end‐points, the areas under the curve (AUCs) for CL with HR were 0.733 and 0.777, and the AUCs for CL with IOS were 0.754 and 0.787, respectively, The AUC for HR was 0.750 at the third end‐point. With receiver operating characteristic (ROC) analysis, the best cut‐off value for CL was ≤1.38 cm and that for IOS was ≥0.35. The AUCs of the TVU scoring system by the cut‐off values for CL and IOS for the three end‐points were 0.784, 0.833, and 0.855, respectively. The predicting values of both methods were better than those of the BS (AUC = 0.672, 0.694, and 0.687, respectively). Conclusion: Cervical length along with E‐Cervix showed better predictive values for successful induction compared with the BS. Synopsis: Cervical length combined with cervical elasticity measured by E‐Cervix is an objective assessment of cervical favorability, with a better predictive value than the Bishop score. [ABSTRACT FROM AUTHOR]

Introduction: There is evolving literature on the superiority of transperineal ultrasound (TPU) in predicting the mode of delivery either before induction or during the course of labour. An ultrasound score (USG score) similar to a Bishop score or an ultrasound scoring method based on independent predictors before the onset of labour at term gestation would serve as a baseline objective record over which further progress of labour could be evaluated. Objective: 1. To sonographically examine the clinical parameters evaluated during a digital examination. 2. To derive an USG score using TPU parameters, similar to a Bishop score, and determine its performance in predicting pregnancy outcomes. 3. To identify which are the independent predictors of caesarean section among all the studied ultrasound (USG) parameters. Materials and methods: In this prospective study, all the eligible women who came for routine antenatal care at term gestation and who were due for pelvic assessment were recruited. They underwent transabdominal ultrasound (TAS) for evaluating head position and head circumference, and TPU for evaluating head station with and without applying fundal pressure, various cervical parameters, sub pubic angle. Equivalent five USG parameters were scored along similar lines as the Bishop score. These women underwent vaginal examination for Bishop score and pelvic adequacy by an obstetrician who was blinded about USG parameters. While spontaneous onset of labour (SOL) was awaited in some of these women, some were induced as and when indicated. After delivery, the Bishop scores, pregnancy outcome in terms of SOL or induction of labour (IOL), mode of delivery and duration of labour were noted retrospectively from case records. Independent predictors of caesarean were obtained by univariate and multivariate analysis. Results: All the parameters were assessed for predictive ability of caesarean section by univariate analysis. The cervical length, angle of progression (AOP) at rest, head perineal distance (HPD) at rest and with pressure, Bishop score and USG score were found significant. On multivariate analysis, cervix length and USG score were found to be statistically significant. At a USG score of ≤ 5, the sensitivity and specificity to predict caesarean section were 84% and 68%, respectively. The relative risk (RR) was 4.9 (95% CI 2.3–12). The USG score could predict SOL. The p value was 0.001. The area under the curve (AUC) for the ultrasound score was 0.74. Conclusions: USG examination by USG score at term gestation before the onset of labour can predict mode of delivery by caesarean section. It can predict spontaneous onset of labour. However, among all the individual parameters, cervix length has best predictive ability for caesarean section. [ABSTRACT FROM AUTHOR]

Introduction: There are mechanical and pharmacologic methods of cervical ripening that combination of these methods had better results. This study was performed aimed to investigate the effect of extra-amniotic dexamethasone infusion on cervical ripening and Bishop score, labor duration and maternal and neonatal complications. Methods: This randomized clinical trial study was performed on 60 term pregnant women with unripe cervix who were candidates for induction of labor in Amiralmomenin hospital of Semnan in 2019-2020. The subjects were randomly assigned into intervention (extra-amniotic dexamethasone infusion through the intracervical catheter) and control groups (extra-amniotic normal saline infusion). Both groups underwent labor induction and the information about the delivery process including latent and active phase duration, time needed for catheter removal, bishop score after catheter removal, cesarean rate and first and fifth minutes Apgar score of neonates entered in a checklist. Data were analyzed by SPSS (version 23) and T-test, U-Man-Whitney and Chi-square tests. P

Determination of the Bishop score (BS) is a traditional method of assessing the cervix in obstetrics and gynecology. This examination is characterized by subjectivity of assessment and low repeatability. In scientific studies intended to evaluate the results of the procedure based on the initial assessment, it is necessary to find an objective scale based on ultrasonography. We selected five ultrasound parameters, measured with a transvaginal transducer, that are equivalent to the individual BS axes (dilatation assessed in three-dimensional ultrasound (DL), angle of progression (AoP), vagino-cervical angle (VCA), strain elastography using the E-Cervix module, and cervical length (CL)). All selected parameters were characterized by good to excellent repeatability (intraclass correlation coefficient (ICC) = 0.878–0.994) and reproducibility (ICC = 0.826–0.996). Each of the selected parameters significantly correlated with its corresponding BS axis. The highest value of the correlation coefficient was achieved with CL (−0.75) and DL (0.71). Other parameters were characterized by an average to high correlation (AoP and station = 0.69, hardness ratio and consistency = −0.33, position and VCA = −0.38). The best correlation with the sum of the BS points was exhibited by AoP (0.52) and CL (−0.61). The selected ultrasound parameters analogous to the BS axes were characterized by high repeatability and significant correlation with the axes of the original clinical BS. Further research into the predictive properties of a multivariate model based on these parameters is needed. [ABSTRACT FROM AUTHOR]

Objective: To determine predictors of efficacy for cervical ripening among the Bishop score criteria in nulliparous women at term. Method: Prospective observational study of nulliparous women with singleton term fetuses in vertex presentation, intact membranes, and an unfavorable cervix (Bishop score < 6) who underwent cervical ripening with a cervical‐ripening balloon (CRB; n = 47) or dinoprostone vaginal insert (PG; n = 28). The authors analyzed Bishop score criteria (dilatation, effacement, fetal station, consistency, position) before and after device removal. Primary outcome was favorable cervix (Bishop score ≥ 6) after device removal. Secondary outcomes were vaginal delivery, modification of Bishop score criteria, and perinatal morbidity. Results: Rates of favorable cervix after cervical ripening were similar between groups (66.7% with CRB vs. 59.3% with PG; P = 0.526). Vaginal delivery (76.6% vs. 78.6%; P = 0.843) and perinatal morbidity did not differ between groups. CRB appeared to be more effective than PG in increasing consistency (+0.7 ± 0.2 vs. +0.3 ± 0.2; P = 0.001) and dilatation of the cervix (+1.3 ± 0.3 vs. +0.9 ± 0.3; P = 0.005). No Bishop score criterion was found as a significant predictor for vaginal delivery. Conclusion: CRB seems to be more effective than PG in increasing the consistency and dilatation of the cervix. Efficacy of CRB and PG for vaginal delivery was similar. Synopsis: Cervical‐ripening balloon appears to be more effective than dinoprostone vaginal insert in increasing consistency and dilatation of the cervix in nulliparous women at term. [ABSTRACT FROM AUTHOR]

Induction of labor by using available, inexpensive and non-invasive methods with the least side effects is particularly important. A systematic review was conducted to assess the effect of evening primrose oil on cervical ripening in term pregnancies. In this systematic review and meta-analysis of clinical trials, a search was carried out in PubMed, Cochrane Library, Embase, Ovid, Scopus, Clinical Trials.gov, Google Scholar and Persian databases (Magiran, SID, and IRCT.ir) for published related articles without any time limit. The Cochrane handbook was used to determine the risk of bias of the included articles. The obtained data were analyzed in RevMan and reported in forest plots. The Odds Ratio (OR) was used to find the effect of the dichotomous data and the Mean Difference (MD) for the continuous data. The heterogeneity of the studies was assessed using I2, T2 and Chi2. The random effect was used instead of fixed effect if I2 >40%. A total of 28 titles and abstracts were extracted, 9 articles entered into the meta-analysis. The meta-analysis results showed significant differences between EPO and control groups in terms of bishop score (MD=1.32; 95% CI: 0.98 to 1.66), reducing caesarean section rate (OR= 0.61; 95% CI: 0.43 to 0.86), duration of first stage of labor (MD= -98.67; 95% CI: -140.98 to -56.38) and duration of second stage of labor (MD= -10.98; 95% CI: -21.86 to -0.09). There were no significant differences in terms of birth weight (MD= 100.97; 95% CI: -11.91 to 213.84) and the frequency of induction with oxytocin (OR= 0.53; 95% CI: 0.27 to 1.01). It seems evening primrose oil be effective for cervical ripening, reducing cesarean section rate and shortening the duration of labor. Due to the high heterogeneity of the studies, the researchers recommend further researches on the subject using a standard tool based on the CONSORT statement. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal and neonatal outcomes between oxytocin and vaginal misoprostol induction in women with term prelabor rupture of membranes (PROM) and unfavorable cervixes. Methods: In this retrospective study, 589 pregnant women with term singleton fetuses in cephalic presentation, reactive nonstress tests, PROM of 2–24 h duration, Bishop score <6, and no previous uterine surgery were reviewed and divided into oxytocin (n = 301) and misoprostol (n = 288) groups. The primary outcomes were the rate of vaginal delivery and delivery within 24 h. Results: After 24 h of induction, the misoprostol group showed a significantly higher proportion of vaginal delivery (64.6% vs. 49.5%, P < 0.001) and a lower cesarean section delivery rate (11.5% vs. 25.2%, P < 0.001) than the oxytocin group. More primiparas in the misoprostol group achieved vaginal delivery within 24 h than in the oxytocin group (60.5% vs. 45.4%, P = 0.001). Among primiparas, the misoprostol group had a significantly lower cesarean delivery rate (12.6% vs. 27.5%, P < 0.001). Conclusion: Vaginal misoprostol induction in term PROM gravidas with unfavorable cervixes was associated with lower cesarean section and higher vaginal delivery rates within 24 h than oxytocin infusion. Vaginal misoprostol and oxytocin infusion had similar maternal and neonatal outcomes. Synopsis: This retrospective study showed that vaginal misoprostol was more effective in induction and vaginal delivery for women with term PROM and unfavorable cervixes. [ABSTRACT FROM AUTHOR]

Objectives: Induction of labor is indicated if the risk of continuing pregnancy is higher (either for fetus or mother) than the risk associated with the induction itself. The purpose of the present study was to compare the effectiveness of the double balloon Cook catheter and pharmacological preparations -- prostaglandins (PGE), in our case it was misoprostol (PGE1) or dinoprostone (PGE2) for cervical ripening in pregnant women with gestational age at term. Material and methods: The prospective observational study was conducted from March 2017 to December 2018. We used mechanical and pharmacological methods for cervical ripening. We compared the efficiency of methods and time to delivery from start of cervical ripening. We also evaluated the neonatal complications by Apgar score and neonatal intensive care unit admission in three different groups. Results: Two hundred and nine women were chosen for cervical ripening. Double balloon Cook catheter and misoprostol were equally efficient in achieving vaginal delivery (76%). The shortest time for cervical ripening and successful vaginal delivery was shown in misoprostol (PGE1) group. In conclusion, no significant differences were found between groups in all neonatal outcomes. Conclusions: Currently, many methods of delivery preinduction exist and the prevalence of their usage varies considerably between countries. As yet, there is no literature comparing these three methods for the preparation of cervix. [ABSTRACT FROM AUTHOR]

Objectives: Post-term pregnancy is a condition associated with increased maternal and fetal complications. Administration of castor oil causes cervical stimulation by increasing the production of prostaglandins. We examined the effects of castor oil on cervical ripening and labor induction through a systematic review and meta-analysis.Methods : : The search process was performed to obtain relevant articles from databases including Pubmed, Cochrane library, Scopus, Science direct, SID, Iran Medex, and Google Scholar using the English keywords of cervical ripening, post-term, castor oil, labor induction, Bishop score, and pregnancy considering all possible combinations without time constraints and their Persian equivalents from national databases.Results : : A total of eight related articles from the 19 primary studies were extracted and systematically reviewed. According to a cumulative chart, the difference in the post-intervention Bishop score was statistically significant (standard mean difference [SMD]: 1.64, 95% confidence interval [CI]: 1.67-2.11, p = 0.001), indicating an effect of castor oil on increasing the Bishop score. In addition, the difference in labor induction was statistically significant after the intervention (odds ratio: 11.67, 95% CI: 3.34-40.81, p = 0.001), indicating an effect of castor oil on increasing the odds ratio of labor induction (experience of vaginal delivery).Conclusion : : This meta-analysis showed that oral administration of castor oil is effective for cervical ripening and labor induction. Midwives should closely monitor pregnant women with prolonged labor and collaborate with obstetricians to employ castor oil as a safe intervention to induce cervical ripening and labor to prevent undue caesarean surgery.

Abstract Background In today's obstetric practice, induction of labour is a common procedure. Before the imaging era, the favourability of the cervix was assessed by manual examination scored as the Bishop Score. However, subjectivity and high inter- and intra-observer variability are limitations of this approach. This necessitates the implementation of an objective method of assessment. We used transvaginal sonography (TVS) as an objective method of assessment of cervix by TVS cervical score comprising of five different parameters; cervical length, funnelling at the internal os, distance from the presenting part to the external os, and cervix position. This study aims to evaluate the role of the pre-induction transvaginal ultrasonographic (TVS) cervical score in predicting labour outcome and comparing it to the Bishop score in patients undergoing induction of labour. Methodology This observational prospective study included 100 pregnant women admitted for labour induction at a single tertiary care centre. The TVS examination which consisted of five parameters was performed after the clinical Bishop scoring. The TVS scores were compared with the Bishop scores for all patients. Labour induction was done within one hour of examination and the outcome of the induction was recorded. Results The mean age was 25.87 years [SD = 4.35]. Labour induction was successful in 74% of patients. At cut-off Scores of ≥ 4, TVS cervical Score performed better than Bishop Score (Sensitivity 93.24 vs. 67.57%, Specificity 73.08 vs. 65.38%). ROC analysis indicated that Area Under Curve (AUC) was more for TVS Score (0.91, 95% CI 0.84–0.97), compared to Bishop Score. Conclusion Transvaginal ultrasonography is an objective method of cervical assessment. We conclude from our study that the use of TVS score which consists of five different parameters in cervical assessment provides a better prediction of successful labour induction than the Bishop score, and so can prevent various complications associated with induction failure.

Background and purpose: The results of various studies on the effect of evening primrose oil (EPO) on cervical ripening are controversial. The purpose of this systematic review and meta-analysis was to assess the effect of EPO on cervical ripening and birth outcomes. Materials and methods: The Cochrane Library, Embase, PubMed, Scopus, Web of Science and Persian databases were searched for studies published from the inception of the databases up to February 2021 (search updated in May 2022). Full-text articles published in English or other languages, randomized controlled trials, and quasi experimental studies with control group were included. Studies published in form of conference proceedings, and those whose full texts were not available, as well as studies with control groups receiving other treatments for cervical ripening, and those in which the intervention group received drugs besides EPO were all excluded. The Cochrane handbook was used to determine the risk of bias of the included studies. All data were analyzed using Review Manager 5.4 and reported in forest plots. Results: Seven trials involving 920 women were included in the meta-analysis. In five studies, including 652 participants, cervical ripening was evaluated using Bishop score. The use of EPO was found to significantly improved Bishop score (MD = 3.23; 95% CI: 3.17, 3.29). The meta-analysis showed no significant differences between two comparison groups in terms of 1-min Apgar score and length of the second stage of labor. However, the two groups were significantly different in terms of their 5-min Apgar score and the time interval between administration of EPO and birth. Based on subgroup analysis by route of administration, both vaginal and oral use of EPO increased Bishop score significantly in the intervention group compared to the placebo group. Conclusion: This study showed that using EPO in term and post-term pregnant women was clinically effective in improving their Bishop score.

Induction of labor (IOL) is becoming a universal topic in Obstetrics, when the risk of continuing a pregnancy outweighs the benefits. Preinduction is a more recent tool to prepare the cervix when the BISHOP-score is low. About one-third of IOL cases require cervical ripening, which is the physical softening, thinning, and dilation of the cervix in preparation for labor and birth. We report a single center experience regarding the use of hygroscopic dilators in the pre-labor phase to obtain cervical ripening before labor induction. We conducted a retrospective observational study comparing patient records from the Gynecology and Obstetrics Unit in "Santo Stefano" Hospital in Prato, Tuscany. The inclusion criteria for participants were women who had undergone pre-labor induction because of a BISHOP-score < 3. The gestational age of all the pregnant women was at term (> 37 weeks). From January 2022 to April 2022, a total of 581 women delivered at term of gestational age at the Gynecology and Obstetrics Unit in "Santo Stefano" Hospital. Cervical ripening was necessary for 82 women with a Bishop score < 3 and hygroscopic cervical dilators were used in 35/82 (42.7%) patients. All patients showed a change in Bishop-score upon removal of the dilators. All 35 patients (100%) reported an increase in terms of consistency and dilation of the cervix but not in terms of length. None of the patients reported discomfort during the 24 h that they kept the hygroscopic dilators in place. No patients reported uterine tachysystole on cardiotocographic tracing, vaginal bleeding, rupture of membranes or cervical tears. Our results are in line with those in the literature, demonstrating the validity of hygroscopic dilators in cervical maturation of pregnancies at term and their efficacy was again highlighted in terms of both maternal and fetal safety and patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To compare the ability of six scoring systems to predict successful labor induction with cervical ripening among women with a Bishop score <3. Methods: Secondary analysis of data from a prospective, multicenter observational Methods of Induction of Labor and Perinatal Outcomes (MEDIP) cohort study in 94 obstetrical French units. We included women with a Bishop score <3 before cervical ripening. We compared six scores: Bishop, simplified Bishop, modified Bishop, simplified Bishop including parity, Hughey, and Levine scores. Vaginal delivery defined successful labor induction. The ability of each score to predict successful labor induction was evaluated by comparing their area under the curve (AUC). Results: Among the 600 eligible women in this study, 408 (68%) delivered vaginally. Body mass index (calculated as weight in kilograms divided by the square of height in meters; mean ± standard deviation [SD]: 24.7 ± 5.5 vs 26.0 ± 5.7; P = 0.01) and nulliparity (48.8% vs 85.4%; P < 0.001) were lower in the successful induction group, whereas height was higher (mean ± SD: 165.3 ± 6.0 cm vs 163.7 ± 6.0 cm; P = 0.002). The simplified Bishop including parity, Hughey, and Levine scores had the highest AUC (0.70, 95% confidence interval [CI] 0.65–0.73; 0.68, 95% CI 0.64–0.74; and 0.69, 95% CI 0.65–0.74, respectively). Conclusion: In women with a very unfavorable cervix, scores that include parity predict successful labor induction more accurately, such as simplified Bishop including parity, Hughey, or Levine scores. Synopsis: In 600 women with a very unfavorable cervix, prediction of successful labor induction is more accurate with scores including parity. [ABSTRACT FROM AUTHOR]

Objective: Predicting likelihood of vaginal birth after cesarean (VBAC) is a cornerstone in counseling patients considering a trial of labor after cesarean (TOLAC). Yet, the simplified Bishop score (SBS), a score comprised cervical dilation, station, and effacement assessment used to predict successful vaginal delivery, has not been applied to the TOLAC population. We evaluated the relationship between admission SBS and likelihood of successful VBAC. We also determined the predictive characteristics of SBS, compared to cervical dilation alone, for successful VBAC. Methods: This is a secondary analysis of a prospective cohort study of patients with a singleton gestation, ≥37 0/7 weeks gestation, and prior cesarean admitted to Labor & Delivery between 2010 and 2014. The primary outcome of successful VBAC was compared between those with a favorable (score >5) and unfavorable (score ≤5) admission SBS. Secondary outcomes were select maternal and neonatal outcomes. Adjusted risk ratios were estimated using multivariable logistic regression analyses. Receiver-operating characteristic curves compared predictive capabilities of cervical dilation alone to SBS for successful VBAC. Results: Of the 656 patients who underwent a TOLAC during the study period, 421 (64%) had a successful VBAC. 203 (31%) and 453 (69%) had a favorable and an unfavorable admission SBS, respectively. After adjusting for body mass index and prior vaginal delivery, patients with a favorable admission SBS had a 30% greater likelihood of successful VBAC compared to those with an unfavorable SBS (aRR 1.30, 95% CI 1.16–1.40). Admission cervical dilation alone performed similarly to SBS as a predictor of successful VBAC, with a receiver-operator characteristic curve area under the curve (AUC) of 0.68 (95% CI 0.64–0.72) versus an AUC 0.66 (95% CI 0.62–0.70), respectively (p = .07). There were no differences in adverse maternal or neonatal outcomes between those with an unfavorable and favorable SBS. Conclusions: A favorable admission SBS is associated with an increased likelihood of VBAC. Although both admission SBS and cervical dilation alone are only modest predictors of VBAC, admission cervical dilation performs overall similarly to current models for VBAC prediction and is an objective, reproducible, and generalizable measure. Our study highlights the value of waiting until end of pregnancy (rather than the first prenatal visit) to conclude patient counseling on the decision to TOLAC in order to consider admission cervical assessment, particularly cervical dilation. [ABSTRACT FROM AUTHOR]

Introduction Labor induction is an important issue in modern obstetrics. One of the important factors for the success of induction of labor is the Bishop score of cervix. Objective The purpose of the present study was to evaluate and compare the efficacy of dilapan with extra-amniotic saline infusion and oral misoprostol for cervical ripening in term pregnancies. Methods This clinical trial study was performed on 120 nulliparous pregnant women with the Bishop score of less than 5. Group one, group two and group three received dilapan, extra amniotic saline infusion (EASI) and misoprostol respectively. All three groups were compared for duration from beginning of the intervention up to cervical ripening and Bishop Score of ≥7, duration of active phase and the second stage of labor, number of deliveries in the first 24 h, duration from beginning of the intervention up to delivery, rout of delivery as well as neonatal weight, neonatal Apgar score; hyper- stimulation, and need for oxytocin and oxytocin doses administered after 12 h of intervention. Results The number of deliveries in the first 24 h after intervention were not significantly different between the three groups. There was no significant difference between the three groups according to duration from beginning of the intervention up to cervical ripening and Bishop Score of ≥7, duration of active phase and the second stage of labor, duration from beginning of the intervention up to delivery, rout of delivery as well as neonatal weight, neonatal Apgar score; and hyperstimulation. The Bishop Score was higher in the misoprostol group 6 h after intervention [dilapan: 4.32 ± 1.38, EASI: 5.47 ± 1.28, and misoprostol: 6.72 ± 1.61 (p = .000)], Oxytocin requirement [dilapan: 38 (95%) women, EASI: 37 (92.50%) and misoprostol: 30 (75%) women, p = .013], and required dose [dilapan: 7543 ± 2465 miu/ml, EASI: 5758 ± 1615miu/ml and misoprostol: 4930 ± 2589miu/ml, p = .000] were lower in misoprostol group. Conclusion Dilapan is an effective and safe method for cervical ripening in full term gestations. In cases where misoprostol and EASI cannot be used or are not desirable, dilapan can be used as an alternative. [ABSTRACT FROM AUTHOR]

Induction of labour (IOL) is of increasing prevalence worldwide and reliable prediction of its successful outcome is important. Traditional clinical methods for predicting successful IOL outcomes have been supplemented with newer technologies. The aim of this study was to compare transvaginal sonographic (TVS) cervical length measurement with Bishop score in predicting labour induction outcomes. This study included pregnant women with term pregnancy, indication for IOL and unfavourable cervix (Bishop score >6) who had TVS performed prior to IOL. Exclusion critetia were regular contractions, ruptured membranes, non-cephalic presentation, uterine scar and pregnancy complications potentially influencing study outcomes. Outcomes measured were successful IOL defined as achievement of active phase of labour and vaginal delivery. Receiver operating characteristic (ROC) curves were used to determine diagnostic accuracy and sensitivity, specificity, positive and negative predictive values. Statistical significance was defined as p<0.05. Among 112 studied participants, IOL was successful in 101 (90.2%) pregnant women. AUC for Bishop score >2 was 0.831 (95% CI, 0.744–0.917, p<0.001) and for cervical length <30 mm 0.679 (95% CI 0.514–0.844, p<0.052). A total of 81 (72.3%) pregnant women delivered vaginally; AUC for Bishop score >2 was 0.754 (95% CI 0.648–0.861, p<0.001) and for cervical length <30 mm 0.602 (95% CI 0.484–0.720, p=0.092) which was the only insignificant predictor. Bishop score >2 is a better predictor for both successful IOL and vaginal delivery among induced women with term pregnancy and unfavourable cervix compared to cervical length <30 mm. [ABSTRACT FROM AUTHOR]

Introduction: In several studies, the effect of evening primrose and castor oil on bishop score and delivery outcomes have been investigated, but comparing their effects is questionable. This study was performed with aim to compare the effect of oral castor oil and evening primrose at the same time with induction of labor on Bishop score and some delivery outcomes in pregnant women. Methods: This triple-blind randomized clinical trial study was performed in 2019 on 114 pregnant women referring to Niknafs maternity hospital of Rafsanjan. The subjects were randomly divided into two intervention group. The first intervention group received two capsules of 1000 mg of evening primrose and the second received 6 capsules of castor oil concurrently with labor induction. Bishop's score information and delivery outcomes were collected using the hospital records. Data were analyzed by SPSS software (version 16) and analysis of variance in repeated measures, Chi-square, and independent t-tests. P0.05).Conclusion: There was no statistically significant difference between evening primrose and castor oil on cervical ripening and pregnancy outcomes at the same time as labor induction, therefore, the use of one is not superior to the other.

Background: The success of induction of labor is dependent on how favorable the cervix is and the unripe cervix thus remains a well-recognized impediment to the successful induction of labor. Objective: The objective is to compare the efficacy of 50 ml versus 30 ml fluid inflation of Foley catheter balloon for cervical ripening in postdate nulliparous women billed for induction of labor. Materials and Methods: A comparative analytical study with randomization involving 88 nulliparous women with postdated pregnancy requiring cervical ripening prior to induction of labor was carried out from January 1, 2018, to August 31, 2018. They were randomized into Group A consisting of women who had 50 ml (study) and B who received 30 ml (control). Bishop score was assessed 12 h later. Data were entered into a pro forma and analyzed using the IBM Statistical Package 20. Results: A total of 88 patients participated in the study. A statistically significant higher mean change in Bishop score was observed in the study group when compared to the control group (5.6 ± 2.5 vs. 3.1 ± 1.6, P = 0.0001), and the difference was statistically significant. Similarly, 41 (93.2%) patients in the study group had a favorable cervix post-ripening, while in the control group, 30 (68.2%) patients had a favorable cervix (P = 0.003). More of the control group had repeat Foley catheter insertion compared to the study group (31.8% vs. 6.8%, P = 0.008). Conclusion: The use of 50 ml of fluid to inflate Foley catheter balloon for cervical ripening improves Bishop score better than the smaller volume of 30 ml.

This study aimed to develop and validate a labor induction nomogram for nulliparous and multiparous women who were 38 weeks pregnant or more and had their labor induced by an unfavorable cervix. This prospective study was conducted on 300 individuals (200 for nomogram development and 100 for nomogram validation). Height, body mass index at delivery, parity, gestational age, adjusted bishop score, and cesarean section risk assessment were all recorded on a checklist. Participants were followed until they gave birth, and the type of delivery was noted in the checklist. Out of 300 labor inductions, 80 (26.7%) underwent a cesarean section. Cesarean risk estimation was the only predictor of delivery type based on multivariate logistic regression. The AUC (Area Under the Curve) in development group was 0.68 and in validation group was 0.71. The developed nomogram for predicting of cesarean section risk following labor induction has a relatively good predictive value among women. [ABSTRACT FROM AUTHOR]

Objective: To compare cervical ripening in women having evening primrose oil with those not taking it. Study Design: Retrospective Cohort study. Setting: Department of Obs & Gynae, Abbasi Shaheed Hospital, Karachi. Period: July 2018 to April 2021. Material & Method: Patients were divided into 2 groups, one having evening primrose oil (EPO) 1gm twice daily from 37 weeks till labor, given by her previous birth attendant. Another group was without using evening primrose oil. Both were examined for cervical ripening by bishop score, length of labour and then for need for cesarean section. Statistical plan: SPSS 20. Results: BISHOP score for EPO group (6.1) vs non-EPO group (4.3) was statistically significant (p-value < 0.001). EPO have soft cervical consistency (73.5%), followed by medium (10.2%) and firm (16.3%) while non EPO have firm consistency (41.2%) followed by soft (37.3%) and medium (21.6%). The differences was statistically significant (p-value=0.001). The average length of labor for EPO group was 7.7 hours (±2.5 SD) and Non-EPO was 8.4 hours (±2.4 SD), statistically insignificant. The mode of delivery wasn't statistically significantly different between two groups. Conclusion: EPO tend to have soft cervical consistency. However mode of delivery between EPO group and Non-EPO group did not have any significant difference. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of intracervical dinoprostone gel and hyaluronidase injection for induction of labour in term primigravida. Materials and methods: This is a hospital based analytical prospective interventional study conducted in a rural tertiary care centre over a period of 18 months. A total of 70 patients who required induction of labour for one or another reason with Bishop score of less than 6 were included in the study. All the cases were randomly divided into two groups, Group A received dinoprostone gel and Group B received hyaluronidase injection. Chi square test & unpaired T test were applied for statistical analysis. Results: Time interval from induction to active phase of labour was comparatively shorter in group A than in group B (10.74 ± 6.17 vs 15.94 ± 7.1) and the difference was significant (p= 0.001). Time interval from induction to delivery time was comparatively shorter in group A than group B (14.84 ± 8.86 vs 21.33 ± 7.86) and difference was significant (P= 0.009). Maternal complications were more common in group A as compared to group B. Conclusion: This study showed that labour could be accelerated significantly by intracervical injection of hyaluronidase. Hyaluronidase injection has less maternal and fetal side-effects as compared to dinoprostone gel and can be a good choice for induction of labour. [ABSTRACT FROM AUTHOR]

This study assessed the effect of dexamethasone on labour induction, Bishop Score, mean intervals from induction of labour to the active phase and delivery, duration of first and second stages of labour and caesarean section frequency. A search was carried out in PubMed, Cochrane Library, Embase, Ovid, Scopus, ClinicalTrials.gov, Google Scholar and Persian databases. The quality of studies was evaluated using Cochrane handbook and the meta-analysis was conducted in RevMan 5.3. The heterogeneity of the studies was assessed using I2, T2 and Chi2. Subgroup analysis was used based on the routes of drug administration. Quality of evidence was assessed using the GRADE approach. 10 studies were included. The results showed significant differences between dexamethasone and control groups in terms of the mean interval from induction of labour to the active phase (MD = −1.55), Bishop score (MD = 2.40), duration of second stage of labour (MD = −8.61) and interval from induction of labour to delivery (MD = −2.83). There were no significant differences in duration of first stage of labour (MD= −0.69) and caesarean section frequency (RR = 1.09). Dexamethasone reduces the time interval between induction and delivery and also accelerates labour through cervical ripening and Bishop Score improvements. What is already known on this subject? Labour induction is a common obstetrics procedure. The desirable condition of the cervix, measured by the Bishop score, is a key to the successful induction. Several mechanical and biomechanical methods are used to achieve desirable cervical ripeness. The role of corticosteroids in the delivery process has not been well demonstrated. What do the results of this study add? The meta-analysis results showed significant differences between dexamethasone and control groups in terms of the mean interval from induction of labour to the active phase. What are the implications of these findings for clinical practice and/or future research? According to the evidences, dexamethasone can be used to reduce the interval between induction to active phase. [ABSTRACT FROM AUTHOR]

Purpose: To compare mode of delivery and maternal and neonatal outcomes using cervical ripening balloon (CRB) for induction of labor (IOL) in nulliparous patients vs. those undergoing first trial of labor after cesarean (TOLAC)., Methods: Retrospective cohort study including data from two tertiary medical centers. Included were all patients with a singleton pregnancy and a gestational age > 37+0 weeks and no prior vaginal birth undergoing IOL with CRB. Nulliparous patients (nulliparous group) were compared to patients with one prior cesarean delivery (CD) and no prior vaginal delivery (TOLAC group). Patients who withdrew consent for trial of labor at any time in both groups were excluded. The primary outcome was mode of delivery., Results: Overall, 161 patients were included in the TOLAC group and 1577 in the nulliparous group. The rate of CD was similar in both groups and remained similar after adjusting for confounders (29.8 % vs. 28.9 %, p = 0.86, OR 1.1, 95 %, CI 0.76-1.58). CD due to fetal distress was more common in the TOLAC group (75 % vs. 56 %, p = 0.014). Other maternal outcomes and neonatal outcomes were similar in the two groups., Conclusion: Comparable vaginal delivery rates may be achieved in patients with or without a previous CD attempting their first trial of labor, with a cervical ripening balloon for labor induction, without increasing adverse maternal or neonatal outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Abstract Background Induction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins. Method A prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated. Pearson χ2 test was used to investigate the significance of association between categorical variables, while student’s t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05. Results Nulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p

Abstract Aim To develop and validate the nomogram for risk estimation of Caesarean delivery and to compare the effect of cervical ripening balloon, evening primrose oil (EPO) and misoprostol on Bishop Score and duration of the first stage of labour. Design The first phase is a prospective study, and the second phase is a randomized controlled trial. Methods In the first phase, the nomogram will be developed and validated over 300 participants, and in the second phase, the 90 participants will be allocated to three groups: vaginal 25mcg misoprostol, vaginal 4000mg EPO and double‐balloon catheter, through block randomization method. The Bishop score will be evaluated every 4 hr, and if required the same dose will be repeated. Maximum waiting time for balloon is 12 hr if not effective, the catheter will be removed, and other interventions will be done according to guidelines. Discussion The nomogram will help informed decision‐making for women undergoing an induction with an unfavourable cervix and introducing effective low‐complication methods of labour induction can improve the pregnancy outcomes.

Objective: To compare the efficacy of intracervical dinoprostone gel and hyaluronidase injection for induction of labour in term primigravida. Materials and methods: This is a hospital based analytical prospective interventional study conducted in a rural tertiary care centre over a period of 18 months. A total of 70 patients who required induction of labour for one or another reason with Bishop score of less than 6 were included in the study. All the cases were randomly divided into two groups, Group A received dinoprostone gel and Group B received hyaluronidase injection. Chi square test & unpaired T test were applied for statistical analysis. Results: Time interval from induction to active phase of labour was comparatively shorter in group A than in group B (10.74 ± 6.17 vs 15.94 ± 7.1) and the difference was significant (p= 0.001). Time interval from induction to delivery time was comparatively shorter in group A than group B (14.84 ± 8.86 vs 21.33 ± 7.86) and difference was significant (P= 0.009). Maternal complications were more common in group A as compared to group B. Conclusion: This study showed that labour could be accelerated significantly by intracervical injection of hyaluronidase. Hyaluronidase injection has less maternal and fetal side-effects as compared to dinoprostone gel and can be a good choice for induction of labour.

Background: In today's obstetric practice, induction of labour is a common procedure. Before the imaging era, the favourability of the cervix was assessed by manual examination scored as the Bishop Score. However, subjectivity and high inter- and intra-observer variability are limitations of this approach. This necessitates the implementation of an objective method of assessment. We used transvaginal sonography (TVS) as an objective method of assessment of cervix by TVS cervical score comprising of five different parameters; cervical length, funnelling at the internal os, distance from the presenting part to the external os, and cervix position. This study aims to evaluate the role of the pre-induction transvaginal ultrasonographic (TVS) cervical score in predicting labour outcome and comparing it to the Bishop score in patients undergoing induction of labour. Methodology: This observational prospective study included 100 pregnant women admitted for labour induction at a single tertiary care centre. The TVS examination which consisted of five parameters was performed after the clinical Bishop scoring. The TVS scores were compared with the Bishop scores for all patients. Labour induction was done within one hour of examination and the outcome of the induction was recorded. Results: The mean age was 25.87 years [SD = 4.35]. Labour induction was successful in 74% of patients. At cut-off Scores of ≥ 4, TVS cervical Score performed better than Bishop Score (Sensitivity 93.24 vs. 67.57%, Specificity 73.08 vs. 65.38%). ROC analysis indicated that Area Under Curve (AUC) was more for TVS Score (0.91, 95% CI 0.84–0.97), compared to Bishop Score. Conclusion: Transvaginal ultrasonography is an objective method of cervical assessment. We conclude from our study that the use of TVS score which consists of five different parameters in cervical assessment provides a better prediction of successful labour induction than the Bishop score, and so can prevent various complications associated with induction failure. [ABSTRACT FROM AUTHOR]