Is Induction of Labor with Early Rupture of Membranes Associated with an Increased Rate of Clinical Chorioamnionitis?

Objective: The objective of this study was to determine if early rupture of membranes (ROM) in women undergoing induction of labor (IOL) at term is associated with an increased rate of clinical chorioamnionitis. Study Design: A retrospective cohort study was performed on women undergoing IOL. Early ROM was defined as ROM at a modified Bishop score less than 5, cervical dilation less than 4 cm, or cervical effacement less than 80%. The rate of clinical chorioamnionitis was compared between women with early and late ROM. Results: The rate of clinical chorioamnionitis was 8.6% (24/279). ROM at an effacement of less than 80% was associated with a rate of clinical chorioamnionitis of 15.4% (12/78) compared to 6.0% (12/201) at an effacement of equal to or greater than 80%, p = 0.017. The rate of cesarean delivery was higher for patients with early ROM by any definition: 32% compared to 17.5% by modified Bishop score (p = 0.031), 32.4% versus 18.2% by cervical dilation (p = 0.049), and 33.3% versus 14.9% by cervical effacement (p = 0.001). Conclusions: In patients undergoing IOL, early ROM may be associated with an increased rate of clinical chorioamnionitis when performed at a cervical effacement of less than 80% and an increased rate of cesarean delivery.

The Efficacy and Safety of Dinoprostone Vaginal Insert for Labor Induction Following Optimization of Standard Operating Procedure: A Retrospective Study in China

Background:The study aimed to assess the efficacy and safety of dinoprostone vaginal insert in labor induction following optimization of standard operating procedure(SOP)and to discover independent predictors of vaginal delivery.Methods:This study comprised 551 pregnant women who required cervical ripening with dinoprostone before induction of labor.Using univariate and multivariate analyses,independent predictors of vaginal delivery were identified.Results:443 of the 551 women(80.4%)gave birth vaginally.Vaginal delivery was predicted by maternal age(24-30 vs.<24,P<0.001;30-35 vs.<24,P=0.03),gestational age(P=0.005),birth weight(P<0.001),parity(P=0.001),pre-pregnancy BMI(P<0.001),premature rupture of membranes(P=0.001),meconium-stained amniotic fluid(P<0.001),fundal height(P<0.001)and the Bishop score(P<0.001).None of the women exhibited severe postpartum hemorrhage.Conclusions:The maternal age,gestational age,birth weight,parity,body mass index,premature membrane rupture,amniotic fluid contamination,fundal height,and the Bishop score were independent predictors of vaginal delivery.These may guide the clinical use of dinoprostone for induction of labor.

Effectiveness of Dinoprostone and Cook's Balloon for Labor Induction in Primipara Women at Term

Labor induction is commonly used for achieving successful vaginal delivery.This study aimed to compare the effectiveness of dinoprostone and Cook's balloon as labor-inducing agents in primipara women at term.A retrospective cohort study among primipara women was conducted in Hubei Maternity and Child Health Hospital.Basic clinical characteristics were collected.The main outcomes were vaginal delivery rate,cesarean section rate and forceps delivery rate.Obstetric and perinatal outcomes were also compared.Univariate and multivariate analyses were further performed to evaluate the predictors for vaginal delivery within 24 h.A total of 845 eligible primipara women undergoing labor induction were recruited.Of them,141 women were induced with dinoprostone(dinoprostone group,DG),and 704 with Cook's balloon(Cook's balloon group,CG).Groups were homogeneous except more women with premature rupture of membranes in DG,with gestational hypertension in CG(P<0.05).The vaginal delivery rate within 12 h was 1.98%and 16.52%in CG and DG respectively(P=0.0001).Besides,the vaginal delivery rate within 24 h was 37.62%and 52.26%in CG and DG respectively(P=0.0079).DG showed the lower rate of oxytocin augmentation,artificial rupture of membrane and postpartum hemorrhage and the shorter interval from insertion to active labor than CG(P<0.05).Multivariate regression analysis revealed that abortion history,oxytocin augmentation,artificial rupture of membrane,and obstric analgesia were independent predictors for vaginal delivery within 24 h.In conclusion,dinoprostone was more effective than Cook's balloon to induce labor and achieve vaginal birth in the sample of primipara women at term.

An Early Pregnant Chinese Woman with Cerebral Venous Sinus Thrombosis Succeeding in Induction of Labor in the Second Trimester

Cerebral venous sinus thrombosis(CVST)is a rare condition in early pregnancy.A22-year-old Chinese woman at10weeks of pregnancy requested induced abortion and was diagnosed as CVST for a severe headache accompanying with nausea and vomiting.The patient was treated successfully with anticoagulation,followed by amniocentesis,and finally succeeded in induction of labor safely.The diagnosis,treatment and prognosis for this rare condition are discussed in this paper.

Maternal and perinatal outcomes of induction of labor at term in the university clinics of Kinshasa, DR Congo

Objective: This paper aims at assessing outcomes following induction of labor and characteristics likely to predict vaginal delivery. Study design: This is a descriptive retrospective cohort study including all women with singleton pregnancies who delivered at term in the university clinics of Kinshasa, DR Congo, from January 01, 2006 until December 31, 2010. Induction was initiated regardless of cervical status. Methods of induction included: oxytocin perfusion, vaginal Misoprostol, intracervical insertion of the Foley catheter and amniotomy. Results of induction were compared in terms of failure of labor, cesarean section, fetal distress, and neonatal distress. Logistic regression was used to seek for independent contributing factors for adverse outcomes. Results: During the period of the study 115 patients at term (3.2%) were concerned with induction of labor. Means for maternal age, gestational age and weight at confinement were 30.5 ± 5.7 years, 37.95 ± 1.54 weeks and 69.3 ± 15.1 kg, respectively. The mean parity and gravidity were 2.4 ± 1.9 and 2.9 ± 1.9, respectively. The mean Bishop score was 6.2 ± 1.5 at the first induction, with 66 women (57.3%) having less than 7. Indications for induction were: preeclampsia (52 = 54.1%), premature rupture of membranes (34 = 29.5%), post term (17 = 14.6%), gestational diabetes (5 = 4.3%), stillbirth (5 = 4.3%), polyhydramnios (3 = 2.6%) and cardiopathy (1 = 0.8%). Methods of induction at the first attempt included: oxytocin (86 = 74.7%), vaginal misoprostol (20 = 17.3%), transcervical Foley catheter balloon (14 = 12.1%), and amniotomy (1 = 0.8%). Failure to induce uterine contraction at the first attempt was noted in 9/115 (7.8%) women. Vaginal delivery occurred in 78 (66.9%) women, and cesarean section in 34 (29.6%). The majority of cesarean sections were performed at the primary induction, most of them (29/34 = 85.3%) in women with bad Bishop score. Failure of induction was more likely to occur in association with high maternal weight (OR 6.8;CI 1.2 - 39.7), and somewhat birth weight (OR 2.1 but CI containing 1). Risk for cesarean section was increased in association with induction of labor in cases of high maternal weight (OR 10.3, CI 16.0 - 67.0), and somewhat of high birth weight (OR 2.3, but CI containing 1). Fetal distress was associated only with maternal weight (OR 15.7, CI 1.3 - 187.8), and neonatal distress only with Bishop score (OR 10.9, CI 1.1 - 108.0). Conclusion Induction of labor in our setting in order to get vaginal delivery is affected of a high risk of adverse outcomes such as failure of induction, cesarean delivery, fetal and neonatal distress. This risk is significantly influenced by maternal weight, birth weight and Bishop score. Lack of worse outcomes between the first and the subsequent attempts to induce labor can be regarded as a reason to try induction even in the presence of unfavorable cervix.

Oral Misoprostol 2 Hourly for Labor Induction

The objective of this study was to assess the efficacy and safety of the 2 hourly oral misoprostol for labor induction. Between May and November 2013, the hospital records of 83 women who were induced for labor and met the eligibility criteria were retrospectively reviewed. Eligibility criteria were singleton pregnancy of at least 34 weeks’ gestation and a baseline Bishop score 6. Women with a previous cesarean section or other uterine surgery, severe pregnancy-induced hypertension, and parity of 4 or more were excluded. Oral misoprostol was administered as 20 μg 2 hourly unless active labor. A maximum of 12 doses was allowed. The age of the women was 27.9 ± 5.3 years (mean ± SD). Vaginal delivery within 24 hours occurred in 38 (45.8%) women. Cesarean delivery occurred in 17 (20.5%) women. Although more parous women achieved vaginal delivery within 24 hours (52.6%) compared with nulliparous women (40.0%), the difference was not significant (P = .35). Uterine tachysystole occurred in 12 (14.5%) women. No perinatal deaths or neonatal intensive care unit admission occurred in the study group. Evidence supporting an optimal regimen is lacking, and additional research is warranted to optimize the use of oral misoprostol for the induction of labor.

Comparison of Bishop score and cervical length measurement through transvaginal ultrasound as prediction against labor induction

Objective:To compare the Bishop score and cervical length measured by transvaginal ultrasound concerned with prediction over the success of labor induction.Methods:This cross-sectional observational analytical study was conducted from May 2017 to October 2017 at several teaching hospitals of Obstetrics and Gynecology Department, Faculty of Medicine Hasanuddin University of Makassar, India. There were 110 samples of pregnant women undergoing labor induction process including 79 samples of successful induction and 31 samples of induction failure. The data analysis used Pearson Chi-square test and multivariate logistic regression to see the effect of Bishop score and measurement of cervical length with successful induction of labor.Results: Number of samples with successful labor induction with Bishop score <3 was 25 (31.6%) and Bishop score≥3 was 54 (68.4%), with rate ratio=3.714 andP=0.000. With measurement of cervical length (cut-off point 2.98 cm), number of samples with successful labor induction with cervical length≤2.98 cm was 12 (15.2%) and cervical length >2.98 cm was 67 (84.8%), with rate ratio=3.124 andP=0.000. Multivahate analysis of logistic regression was found to be more influential in the predicted success of labor induction (P=0.014 with Bishop score <3, odds ratio=1.000 and Bishop score≥3, odds ratio=3.779. Conclusions: Bishop score is better in predicting the success of labor induction compared to the measurement of cervical length through transvaginal ultrasound.

Comparison of transvaginal cervical length and modified Bishop's score as predictors for labor induction in nulliparous women

Objective: To compare the transvaginal cervical length (TVCL) to the modified Bishop's score for prediction of successful labor induction in nulliparous women. Methods: A total of 210 nulliparous women who were diagnosed as premature rupture of membranes were recruited in this comparative prospective study, which was carried out in the Obstetrics and Gynecology Department of Ain Shams University, Egypt over two years for labor induction. The studied women were examined by trans-vaginal ultrasound for measurement of the cervical length (CL) and vaginally to calculate the modified Bishop's score, followed by induction of labor. Collected data were analyzed to compare the TVCL to the modified Bishop's score for prediction of successful labor induction in nulliparous women. The success of induction process was defined as vaginal birth after the induction of labor. Results: One hundred and forty-three women of studied women had CL <28 mm;122 of them delivered vaginally (P=0.030). One hundred and forty-six women of studied women had modified Bishop's score >4;128 of them delivered vaginally (P=0.006). The CL <28 mm was significantly more specific with more positive predictive value as predictor of successful labor induction compared to modified Bishop's score. Induction to delivery time was significantly shorter in women with CL <28 mm than women with CL ≥28 mm (P=0.02;95% confidence interval: 4.9-8.4). In addition, induction to delivery time was significantly shorter in women with Bishop's score >4 than women with Bishop's score of 曑4 (P=0.01;95% confidence interval: 1.6-4.5). Conclusions: Both TVCL and the modified Bishop's score are complementary tools in pre-induction cervical assessment before induction of labor, while the TVCL at <28 mm is significantly more specific with more positive predictive value as predictor of successful induction than the modified Bishop's score.

Comparative study for success rate of vaginal birth after cesarean section following labor induction by two forms of vaginal dinosprostone: A pilot study

Background: Cesarean delivery has become the most common major surgical procedure in many parts of the world. Induction of labor in women with prior cesarean delivery is an alternative to mitigate the rising cesarean rates. Objectives: To compare the VBAC success rate between two vaginal forms of dinoprostone for labor induction in women with prior cesarean section. Material and Methods: A pilot study was conducted at a large Governmental Hospital, Dhahran, Saudi Arabia, including 200 women with prior cesarean section and planned for labor induction. Participants were randomly allocated into two groups. Group A (n = 100) received dinoprostone 1.5 mg vaginal tablet. Group B (n = 100) received 10 mg dinoprostone sustained release vaginal pessary. Primary outcome was vaginal delivery rate. Secondary outcomes included maternal and neonatal outcomes. Results: The dinoprostone vaginal tablet and dinoprostone vaginal pessary had a comparable vaginal delivery rate (67% and 64%, respectively;p = 0.78). The median patient satisfaction with the birth process was superior in the dinoprostone vaginal pessary group (p = 0.04). Maternal and neonatal outcomes were similar in both groups. Conclusion: Both forms of dinoprostone were effective methods for labor induction in women with prior cesarean section. However, the patient satisfaction with the birth process was in favor of the dinoprostone sustained release vaginal pessary.

The Epidemiology of Induction of Labor among Women Aged 15 - 49 Who Delivered at Shaafi Hospital in Hodon District, Mogadishu Somalia 2020

Background: Induction of labor is an artificial termination utilized to decrease both maternal and neonatal morbidity and mortality. The study was aimed to assess the epidemiology of induction of labor among women aged 15 - 49 who delivered at Shaafi Hospital in Hodon District, Mogadishu Somalia 2020. Methodology: A cross-sectional and retrospective hospital-based study was conducted among 30 women aged 15 - 49 who had undergone induction of labor who were delivered at Shaafi Hospital Mogadishu during the period of the study from May-July 2020. Data were collected by interview method using structured questionnaire. Data analyzed was performed using Statistical Package for Social Science version 20. Results: The study showed that the majority of respondents 12 (40%) had undergone induction once time previously, followed by 8 (27%) had undergone induction previously two times, while 6 (20%) had undergone previously three times, 4 (13%) more than four times. 21 (70%) were delivered Spontaneous Vagina delivery (SVD), 6 (20%) were Cesarean section (CS) and 3 (10%) instrumental vaginal delivery. A total of (60%) were delivered in public hospitals, followed by (23%) were delivered in private hospitals and 5 (17%) home delivery. In addition the reasons of induction of labor a total of 27 (90%) were post term, followed by 2 (7%) were Intrauterine fetal death (IUFD), while few proportion of 1 (3%) were Pregnancy induced hypertension (PIH). Finally, the study revealed that the socio-demographic and obstetrical determinants such as age and daily meal intake as well as antenatal care visit and reasons for induction of labor e.g. Post term (Post-mature), Intrauterine fetal death (IUFD) and Pregnancy induced hypertension (PIH) showed significant association with their the induced labor (P Conclusion and Recommendations: The study recommended that ministry of health especially maternal and reproductive health unit should ensure that every pregnant woman has access to skilled maternal counseling and improve quality of antenatal, develop a national guideline of induction labor and continue training health workers at health facilities and monitor its implementations across the country.

Induction of Labor with PGE2 after One Previous Cesarean Section: 18 Years Experience in a University Hospital

Objective: To review the outcome of prostaglandin induction of labor in term pregnant women with previous one ce-sarean section compared to those without previous Cesarean section. Design: 18 years retrospective review of hospital records and case note review of index cases. Setting: University hospital. Population: Three hundred and twenty two women who had their labor induced with prostaglandin E2. One hundred and sixty one women had one previous Ce-sarean section. Methods: This study was conducted at King Fahad University Hospital, University of Dammam. It is a tertiary referral center with approximately 2300 births per year. We searched the hospital's records of deliveries from January 1992 to December 2009 and reviewed all indications and outcomes of prostaglandin induction of labor in women with one previous Cesarean section. The control group was composed of women who had their labor induced with prostaglandin but without previous Cesarean section. Main outcome measures: Labor outcome and uterine rup-ture Results: Three hundred and twenty two women were included. All received prostaglandin E2 for induction of labor. One hundred and sixty one women had one previous Cesarean section (study group) and the rest had no previous Ce-sarean section (control group). There was no difference in the rate of vaginal delivery between study and control group, 68.3% and 79.5% (p value 0.3), respectively. The rate of uterine rupture was 30 times higher in study group (2.5% Vs 0.033%). Conclusion: In women with one previous Cesarean section, induction of labor with prostaglandin leads to comparable rate of vaginal delivery similar to those without prior Cesarean section but with relatively high risk of uter-ine rupture.

Combined Rupture of Vaginal Vault and Unscarred Uterus and Neonatal Death Following Induction of Labor with Misoprostol

Introduction: Rupture of unscarred uterus (primary uterine rupture) is a rare peripartum complication often associated with catastrophic maternal and neonatal outcomes. Case presentation: A 27-year-old primigravid lady, previously healthy, at 40 weeks + 2 days presented to a midwife’s clinic for routine antenatal consultation. She was advised to have induction of labor. This was initiated with 2 tablets of Misoprostol (400 mcg) vaginally. Twelve hours later, and after remaining at full cervical dilation for 4 hours, she was referred to our maternity service for alleged failure to descend. On arrival, she was apprehensive, exhausted but hemodynamically stable. Pelvic exam disclosed a fully dilated cervix with the vertex at S + 1 and a caput reaching the introitus. No fetal heart rate could be elicited by the CTG monitor and this was verified by a bedside ultrasonography. Operative vaginal delivery was performed due to maternal exhaustion. This was complicated by transient shoulder dystocia. Manual revision of the birth canal and the uterine cavity disclosed a suspicion of left vaginal vault gapping together with a left fundal uterine rupture. Consequently, the patient was rushed to the operating room for an urgent exploratory laparotomy. The rupture sites were identified and repaired while a large broad ligament hematoma on the same side was explored and hemostasis secured with ipsilateral uterine artery ligation of the fundal and cervical branches. The postoperative course was smooth and the patient left the hospital on the 5th day postpartum. Conclusion: Cases of unscarred uterine rupture are limited. One of the most frequent risk factor is the injudicious use of Misoprostol for labor induction. Sudden arrest of progress of labor or failure to descend might mask uterine rupture. We recommend that all birth attendants be familiar with the guidelines issued by FIGO, ACOG and other societies for the safe use of these potent uterotonics.

Prognostic Factors of Induction of Labor with Misoprostol at CHUD/B in Parakou, Benin in 2016

Introduction: Misoprostol is a molecule used for inducing labor these days in order to reduce perinatal morbidity and mortality. This study aimed at appreciating maternal and fetal prognosis after induction of labor on indication for delivery with misoprostol on live fetus at CHUD/B in 2016. Patients and Method: It was an observational case-control type study with prospective data collection carried out in the gynecology and obstetrics department of CHUD/B. Were included, 37 WA healthy pregnant women whose Bishop score was less than 6. Their fetal heart rate and their pelvis were normal. Fisher chi-2 test was used and the significance threshold of different associations was 5%. Results: In the study, 99 women involved were divided into 33 cases and 66 case-controls. The average age of cases was 29.70 ± 5.03 years old with extremes of 20 and 40 years and that of case-controls was 29.44 ± 4.96 years with extremes of 21 and 40 years. Out of the 1195 deliveries which took place in the gynecology and obstetrics department of CHUD/B, 33 inductions of labor on full-term live fetuses with misoprostol were performed that is to say a frequency of 2.76%. The factors associated with maternal and fetal prognosis were profession, mode of admission, Bishop score with respectively p-values of 0.049, 0.00005, 0.00001. Conclusion: The use of misoprostol seems beneficial as regards maternal and fetal prognoses in our practice at a low cost.

Cervical Ripening and Induction of Labor: Awareness, Knowledge, Perception and Attitude of Antenatal Care-Seeking Women at Zagazig University Hospital, Zagazig, Egypt

To assess awareness, knowledge and perceptions of antenatal care-seeking women about cervical ripening (CR) and induction of labor (IOL), and their attitude towards these interventions. Methods: An observational descriptive cross-sectional study which was conducted at an Egyptian teaching hospital. A questionnaire-based interview covered items on women’s demographic and clinical data, as well as their awareness, knowledge, perception and attitude towards specific methods of CR and IOL. Results: A total of 853 questionnaires were analyzed, and 442 respondents (51.8%) were aware of CR and IOL. Knowledge of Oxytocin use was noted in 215 participants (48.6%), of membrane sweeping in 85 (19.2%), of Foley’s catheter in 110 (24.9%) and of Misoprostol in 84 (19.0%). The procedures were perceived to prevent cesarean section in 219 respondents (49.5%). History of previous IOL was a predictor of awareness (OR: 5.19, 95% CI: 1.6 – 11.23, p = 0.001*). Conclusion: This study showed that only a slightly more than 50% of participants were aware of CR and IOL, and the overall knowledge and perception were sub-optimal. Nevertheless, the attitudes towards the procedures were positive. Improved counselling is required in order to further increase knowledge about CR and IOL, and also correct misbelieves particularly in women at risk of undergoing IOL.

Abruptio Placentae 116 Cases: Role of PGE1 in Cervical Ripening and Induction of Labor, January 2006-August 2006

OBJECTIVES: In the very high risk obstetric cases of placental abruption, expediting delivery is of utmost urgency, since the complications are related to the abruption delivery interval. Before the introduction of prostaglandins for labor induction, it was a routine practice to do amniotomy and use oxytocin drip to accelerate labor when vaginal delivery was contemplated. We present 116 cases of placental abruption, including the severe cases, managed in the year 2006 during a period of 8 months, at Modern Government Maternity Hospital, which was the biggest maternity hospital in the combined state of Andhra Pradesh, and is the biggest in the state of Telangana, attached to Osmania Medical College. The role of prostaglandin E1 (PGE1), for cervical ripening and labor induction/augmentation has been analyzed in this observational study. A variety of variables including age, parity, gestational age, severity of abruption and maternal and fetal status, associated preeclampsia, Bishop score, availability of blood and blood products, associated complications, all factors influence the management adopted. MATERIAL METHODS: The response to PGE1 induction has been studied in terms of efficacy, the total number of doses of vaginal PGE1 in relation to parity, induction delivery interval, successful vaginal delivery rate, the indications for caesarean delivery, perinatal outcome and complications. A decision was made for either abdominal delivery or vaginal delivery on a case to case basis. A routine amniotomy was performed when the cervical os was open, both for confirmation of diagnosis and to release intra uterine pressure, and also it would help in the acceleration of labor. When the Bishop score was more than six, amniotomy was performed and an oxytocin intravenous drip was started. If the Bishop score was less than six, 25/50 mcg. Misoprostol (PGE1) was placed high in the vagina. OBSERVATIONS: Primies that had abruption were 27/116 = 23.27% and multies were 89/116 = 76.72%. In our study 68/116, (58.62%) had preeclamsia. In our series, gestational age at abruption was less than 36 weeks in 89/116, (76.72%) and >36 weeks in 27/116 (23.27%) at presentation. It is significant to note that 100/116 (86.2%) were unbooked and 16/116 (13.79%) were booked cases at our institute. Vaginal deliveries were 84 (74.2%) and caesarean deliveries were 30 (25.8%) in 116 placental abruptions. There were four maternal deaths 3.4%, two died undelivered. Perinatal mortality in our series was 92/116 (79.3%). PGE1 induced labours—49: When PGE1 was used for labor induction in 49 women, 40 (81.63%) had vaginal delivery and caesarean delivery was done in 9 (18.36%) cases for non progress of labor. Induction delivery interval was less than 12 hours in 45 (91.83%), more than 12 hours in 4 (8.1%). Preterm delivery in PGE1 induced cases was 40/49 = 81.63% versus preterm in 116 cases, 76.72%. This indicates that more numbers of preterm deliveries were allowed vaginal delivery. DISCUSSION: Maternal mortality: Better facilities of transfusion of blood products may have reduced maternal mortality in our series. Government maternity hospital is a public sector tertiary health facility providing free treatment. Early referral would make some difference. Acute defibrination leading to disseminated intravascular cougulation was the cause of three deaths, irreversible haemorrhagic shock in another. CONCLUSION: Induction of labor with PGE1 was useful and effective when cervix was unfavorable and Bishop score was less than six. With PGE1 induction (49) 91.83% delivered in less than 12 hours. There were no maternal deaths and PPH in 49 women induced with PGE1. Hence PGE1 was safe to use in these emergency high-risk obstetric patients. PGE1 usage to expedite delivery can reduce Caesarean section rate.

Effects of two different protocols of oxytocin infusion for labor induction on obstetric outcomes: A cohort study

Objective: Concerns remain about the safety and efficacy of high dose and low dose protocols of oxytocin for labor induction. We have compared 2 regimens of oxytocin induction (low-dose vs high dose) on perinatal outcomes over a 1-year period. Study Design: Included were all women undergoing induction of labor at term with live singleton gestations. Cesarean delivery (CD) and a composite adverse neonatal outcome (5-min Apgar score < 7, umbilical artery pH < 7.10, or need for admission to NICU) were assessed using logistic regression analysis. Admission-to-delivery intervals was compared between the two groups by log-rank test. Results: A total of 544 women fulfilled the study criteria. The two groups were comparable for demographic and obstetric variables. There was no significant association between oxytocin regimen and rates of CD (P = 0.77) or adverse neonatal outcome (P = 0.99) even after controlling for confounders. The admission-to-delivery interval was significantly shorter for the high-dose group than for the low-dose group (median interval = 11.7 vs 14.3 hours, respectively, P = 0.026). Conclusion: Use of a high-dose protocol of oxytocin administration for induction of labor at term is associated with similar rates of cesarean section and adverse neonatal outcome as a low-dose protocol, but with an average of 2.5 hours shorter duration of labor.

Automatic &Safe Oxytocin Induction of Labor

Aims: To prevent fetal damage by excess oxytocin administration of manually controlled infusion, by automatic and safe increasing infusion setting with monitoring uterine contraction and fetal heart rate. Methods: Starting infusion level was 2 milliU/ml, as oxytocin sensitivity of a pregnant uterus is unknown, to avoid hyper contraction and fetal bradycardia caused by unexpected excess oxytocin sensitivity. The infusion automatically increased with automatic monitoring of uterine contraction curve, then the increasing stopped when contraction reached to normal labor level, where the infusion level maintained, which continued until delivery, if there is no trouble. However, the infusion continued until expiring all fluid in case of insensitive uterus, where the induction was performed in another day. The infusion stopped automatically when contraction was too strong, or fetal heart rate is abnormal. Thus, oxytocin sensitive case is protected from excess contraction and fetal asphyxia. Results: Normal vaginal delivery was achieved in 28/33 cases (85%), which was more than manually controlled infusion. No case was abnormal in successful oxytocin infusion. Conclusion: The automated technique will be applied to oxytocin labor induction.

Cervical Ripening for Induction of Labor: A Randomized Comparison between Vaginal Misoprostol versus Foley’s Catheter Placement in a Nigeria Tertiary Hospital

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.

Transvaginal Sonographic Assessment of the Cervix for Prediction of Successful Induction of Labor in Nulliparous Women

Background: Induction of labor is commonly performed in obstetric practice. Many methods have been suggested as good predictors of the outcome of labor induction, yet none of them is satisfactory enough. Our study aims to assess cervical length and uterocervical angle measured by transvaginal ultrasound as predictors of successful induction of labor. Methods: Prospective cohort study conducted in Ain Shams University Maternity hospital over 150 nulliparous women undergoing induction of labor, in the period between May 2018 and August 2019. Transvaginal sonographic measurement of cervical length and uterocervical angle was done before induction of labor by prostaglandins. The patients were followed up till delivery and the outcome was recorded. Results: The best cut-off value of cervical length for prediction of success of labor induction was 32.3 mm with 60% sensitivity and 56% specificity and the best cut-off value of uterocervical angle was 110.2 degrees with 87% sensitivity and 93% specificity. The cervical length showed a significant negative correlation while the uterocervical angle showed a significant positive correlation with the success of labor induction. Conclusion: Cervical length and uterocervical angle are good predictors of successful labor induction.

Low-Dose Misoprostol versus Vaginal-Insert Dinoprostone for At-Term Labor Induction: A Prospective Cohort Study

Introduction: Given the pharmacological change taking place in Spanish delivery rooms, we designed this study to compare the effectiveness and safety of misoprostol (25 mcg/4h) to 10 mg dinoprostone in its slow-releasing vaginalinsert form to induce at-term labor. Methods: In a prospective cohort study (2013-2015), 401 at-term pregnant women referred for induction (Bishop score ≤ 6), who gave birth at the Rey Juan Carlos Hospital in Móstoles (Madrid, Spain), of whom 241 participants were induced with misoprostol and 160 with dinoprostone. Patients were recruited by non-probabilistic sampling of consecutive cases as the inductions in the Obstetrics Block during the study period were indicated. Results: The cesarean section rate was 14% for the misoprostol group and 19% for the dinoprostone group [RR = 1.38 (95%CI: 0.89 - 2.13), p = 0.145]. No differences were found in the vaginal birth rate in <24 h from starting induction [44% vs. 53%, RR = 1.08 (0.90 - 1.29), p = 0.401], nor in the vaginal birth rate in <12 h, requiring oxytocin or meconium fluid, or for maternal-neonatal complications deriving from the method employed. The percentage of cesarean sections due to failed induction was lower in the misoprostol group (15% vs. 39%, p = 0.028). The time between induction and giving birth was shorter for the dinoprostone group (20 h vs. 23.4 h, p = 0.018). Conclusion: Inducing delivery by low-dose misoprostol offers similar effectiveness and safety to induction by dinoprostone in its slow-releasing vaginal-insert form. However, our sample is limited, and few studies are available on the subject. Further analyses to draw solid conclusions are required.