Induction and Augmentation of Labor

2019 ◽  
Author(s):  
Christopher M Morosky
Keyword(s):  
Balloon Catheter ◽  
Well Being ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Quiescent State ◽  
Patient Request ◽  
Fetal Maturity ◽  
Elective Induction ◽  
Detailed Assessment

Certain maternal and fetal conditions require induction of labor for the safety and well-being of either the mother or baby. Similarly, once fetal maturity has been reached, elective induction of labor remains an option for delivery timing and patient request. A thorough understanding of the physiologic mechanisms of labor onset and maintenance has allowed obstetrical providers to induce labor from the quiescent state and augment spontaneous labor in the latent or prolonged state. The goal of labor induction and augmentation is the successful and expedited delivery of the neonate in a manner that is safe to both the mother and the infant. Positive maternal outcomes include a shortened admission to onset of labor time, shortened first stage of labor, successful vaginal delivery, and avoidance of intraamniotic infection or postpartum hemorrhage. Positive fetal outcomes include absence of meconium amniotic fluid staining, regular newborn nursery admission, and hospital discharge with the mother. In this review, we outline the various mechanical, chemical, and natural methods of labor induction and augmentation, including a detailed assessment of the risks and benefits of each method for both the mother and baby. This review contains 7 figures, 4 tables, and 33 references. Key Words: amniotomy, augmentation of labor, cervical ripening, induction of labor, oxytocin, membrane sweeping, nipple stimulation, prostaglandins, transcervical balloon catheter

Titrated oral misoprostol solution versus vaginal misoprostol for labor induction in primi gravid ladies

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
I M Abdalfattah ◽  
W E Mohammed ◽  
A A El-gaml
Keyword(s):  
Safety Profile ◽  
Tap Water ◽  
Maternity Hospital ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Controlled Clinical Trial ◽  
Solution Versus ◽  
Oral Misoprostol ◽  
Vaginal Misoprostol

Abstract Background It is now generally accepted that the uterine cervix plays an important role during pregnancy and labor and that it depends on an active ripening process within the cervix; which is necessary for successful labor induction. Aim of the Work to test the safety and efficacy of titrated oral misoprostol compared to vaginal misoprostol for labor induction in term gravid ladies. Patients and Methods This prospective, single-blinded randomized controlled clinical trial was conducted at Ain-Shams University Maternity Hospital during the period between August 2017 and August 2018. 120 pregnant women planned for induction of labor were recruited in the study according to the inclusion / exclusion criteria. Subjects included in the study were randomized into two groups: patients who received oral 200 ug misoprostol in 200 ml water titrated over 24 hours and placebo tablets vaginally which resemble vagiprost tablets (25 microgram misoprostol) and the second group contained pients who received vaginal misoprostol 25microg maximum four doses, and placebo solution of 200 ml of tap water. Results titrated oral misoprostol is as effective in promoting cervical ripening and inducing labor as intravaginal misoprostol, oral Misoprostol has a similar maternal and perinatal safety profile to vaginal misoprostol. Conclusion This new approach to oral misoprostol administration was successful in minimizing the risk of uterine hyper-stimulation, which has been a feature of misoprostol use for induction of labor, at the expense of a somewhat slower response. Oral Misoprostol has a similar maternal and perinatal safety profile compared to vaginal misoprostol.

Intravenous Dexamethasone Versus Vaginal Misoprostol in Enhancing Cervical Ripening and Labor Induction

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Mahmoud Salman ◽  
Fekria Ahmed Salama ◽  
Mina Yacoub
Keyword(s):  
Total Duration ◽  
Active Phase ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Control Group ◽  
P Value ◽  
Time Interval ◽  
Vaginal Misoprostol ◽  
Mean Time

Abstract Background Induction of labor is one of the most common procedures performed in the world of Obstetrics. Traditionally, labor induction is performed using prostaglandin and oxytocin. However, usage of corticosteroids nowadays is gaining a lot of interest regarding its effects on cervical ripening and shortening the physiological process of labor. Aim of work to evaluate the efficacy of intravenous dexamethasone versus vaginal misoprostol in enhancing cervical ripening and labor induction. Patients and Methods A randomized controlled clinical trial was carried out at Ain Shams University Maternity Hospital on (60) full term pregnant women between 39 – 42 weeks undergoing induction of labor, during a period from April 01, 2019 to November 30, 2019. Pregnant women were divided into two groups; vaginal misoprostol (control) group and intravenous dexamethasone (experimental) group (30 cases each). Results Our study showed that the mean time interval (hours) from initiation of labor induction to initiation of active phase was statistically significantly shorter among the dexamethasone (experimental) group 7.36 ± 2.23 versus 12.20 ± 4.92 hours among the vaginal misoprostol (control) group (p value < 0.001). Also, the mean time interval of the total duration between the induction of labor to successful vaginal delivery was statistically significantly shorter among the dexamethasone group 10.90 ± 4.17 versus 19.20 ± 5.62 hours among the vaginal misoprostol group (p value < 0.001). The results of this study showed the rate of initiation of active phase and rate of successful vaginal delivery were more in the experimental dexamethasone group than the control vaginal misoprostol control group. Conclusion Intravenous injection of 8 mg of dexamethasone before induction of labor is found to shorten the duration of labor induction by reducing the time interval between the initiation of labor induction and onset of active phase and the total duration from initiation of labor induction to delivery with no marked maternal or fetal complications. Recommendations Intravenous Dexamethasone can help cervical ripening and accelerate induction of labor. Further research should be taken in consideration with more population for more global evaluation.

scholarly journals Outpatient Induction of Labor – Are Balloon Catheters an Appropriate Method?

2021 ◽  
Vol 81 (01) ◽  
pp. 70-80
Author(s):  
Werner Rath ◽  
Patrick Stelzl ◽  
Sven Kehl
Keyword(s):  
Hospital Stay ◽  
Balloon Catheter ◽  
Induction Of Labor ◽  
Cervical Ripening ◽  
Controlled Study ◽  
Complication Rates ◽  
Balloon Catheters ◽  
Cervical Priming ◽  
Oral Misoprostol ◽  
Uterine Hyperstimulation

AbstractAs the number of labor inductions in high-income countries has steadily risen, hospital costs and the additional burden on obstetric staff have also increased. Outpatient induction of labor is therefore becoming increasingly important. It has been estimated that 20 – 50% of all pregnant women requiring induction would be eligible for outpatient induction. The use of balloon catheters in patients with an unripe cervix has been shown to be an effective and safe method of cervical priming. Balloon catheters are as effective as the vaginal administration of prostaglandin E2 or oral misoprostol. The advantage of using a balloon catheter is that it avoids uterine hyperstimulation and monitoring is less expensive. This makes balloon catheters a suitable option for outpatient cervical ripening. Admittedly, intravenous administration of oxytocin to induce or augment labor is required in approximately 75% of cases. Balloon catheters are not associated with a higher risk of maternal and neonatal infection compared to vaginal PGE2. Low-risk pregnancies (e.g., post-term pregnancies, gestational diabetes) are suitable for outpatient cervical ripening with a balloon catheter. The data for high-risk pregnancies are still insufficient. The following conditions are recommended when considering an outpatient approach: strict selection of appropriate patients (singleton pregnancy, cephalic presentation, intact membranes), CTG monitoring for 20 – 40 minutes after balloon placement, the patient must be given detailed instructions about the indications for immediate readmission to hospital, and 24-hour phone access to the hospital must be ensured. According to reviewed studies, the balloon catheter remained in place between 12 hours (“overnight”) and 24 hours. The most common reason for readmission to hospital was expulsion of the balloon catheter. The advantages of outpatient versus inpatient induction of cervical ripening with a balloon catheter were the significantly shorter hospital stay, the lower costs, and higher patient satisfaction, with both procedures having been shown to be equally effective. Complication rates (e.g., vaginal bleeding, severe pain, uterine hyperstimulation syndrome) during the cervical ripening phase are low (0.3 – 1.5%); severe adverse outcomes (e.g., placental abruption) have not been reported. Compared to inpatient induction of labor using vaginal PGE2, outpatient cervical ripening using a balloon catheter had a lower rate of deliveries/24 hours and a significantly higher need for oxytocin; however, hospital stay was significantly shorter, frequency of pain during the cervical ripening phase was significantly lower, and patientsʼ duration of sleep was longer. A randomized controlled study comparing outpatient cervical priming with a balloon catheter with outpatient or inpatient induction of labor with oral misoprostol would be of clinical interest.

Intracervical double‐balloon catheter versus dinoprostone for cervical ripening in labor induction in pregnancies with a high risk of uterine hyperstimulation

2021 ◽  
Author(s):  
Javier Vega Cañadas ◽  
María Teulón González ◽  
Natalia Pagola Limón ◽  
María Sanz Alguacil ◽  
María García-Luján Prieto ◽  
...  
Keyword(s):  
High Risk ◽  
Balloon Catheter ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Double Balloon ◽  
Uterine Hyperstimulation

scholarly journals INDUCTION OF LABOR

2011 ◽  
Vol 18 (02) ◽  
pp. 201-207
Author(s):  
TAHIRA JABBAR ◽  
SHAMAILA FAISAL ◽  
FAIQA IMRAN ◽  
Robina Kauser
Keyword(s):  
Prostaglandin E2 ◽  
Foley Catheter ◽  
Balloon Catheter ◽  
Fetal Distress ◽  
Induction Of Labor ◽  
The Other ◽  
Cervical Ripening ◽  
Prostaglandin E ◽  
Additional Advantage ◽  
Significant Difference

background: Labor can be induced through a myriad of ways. The aim of this study was to compare the effectiveness of the intracervical Foley balloon catheter and intra vaginal 3 mg prostaglandin E2 tablet(s) in preinduction cervical ripening at term. Methods: Prospective analytic study of a cohort of 280 women selected through non probability sampling admitted in Obstetrics units, in two private hospitals one at Rawalpindi and the other at Mirpur (Azad Kashmir), from January 2009 to March 2010. All women were randomized to receive an intracervical Foley catheter or prostaglandin E2 tablets. The primary measured outcome was ripening of the cervix as measured with the Bishop score. Results: There were no differences in mean Bishop Scores between the prostaglandin and the Foley catheter groups. Bishop scores (mean ± S.D.) after ripening were 6.6±0.81 and 6.7±0.86 for the Foley catheter and prostaglandin groups, respectively (P=0.54). The prostaglandin group showed a statistically shorter induction to delivery time compared with the Foley catheter (16.5±2.2 and 20.51±3.89 h, respectively (P<0.01). Both the groups showed no statistically significant difference between the occurrences of spontaneous vaginal delivery. Labor was established in 72% cases of cervical Foley group. On the other hand induction occurred in 76% cases in prostaglandin group. There was no statistical difference between the need of oxytocin infusion for labor augmentation between the two groups and fetal distress was equally frequent in both the groups. Conclusions: Foley catheter was as effective as Prostaglandin E-2 at term for induction of labor with additional advantage of being cheaper, readily available and had no systemic side effects. 

scholarly journals Premature rupture of membranes

2021 ◽  
Vol 11 (3) ◽  
pp. 363-370
Author(s):  
Sefik Gokce ◽  
Dilsad Herkiloglu
Keyword(s):  
Umbilical Cord ◽  
Balloon Catheter ◽  
Uterine Cavity ◽  
Expectant Management ◽  
Neonatal Infection ◽  
Well Being ◽  
Cervical Ripening ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Membrane Rupture

Prenatal (premature) rupture of membranes (PROM) is defined as rupture of fetal membranes before the onset of labor or regular uterine contractions. PROM can lead to serious complications such as uterine cavity infection, umbilical cord compression, oligohydramnios, fetal malpresentation, umbilical cord prolapse, preterm delivery, fetal asphyxia and death. Initial evaluation of all term pregnancies with suspected PROM should include confirmation of membrane rupture and assessment of maternal and fetal well-being. Immediate initiation of labor is recommended in term pregnant women with PROM. Compared with expectant management, induction of labor is associated with a reduction in maternal and possibly neonatal infection and lower treatment costs without an increase in cesarean delivery. Induction with oxytocin is recommended. Oxytocin is as effective as prostaglandins, easier to titrate and may be less expensive depending on the preparation. Balloon catheter use is not recommended for cervical ripening in PROM.

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