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Induction Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Compared to oxytocin, women treated with mifepristone for PROM after 36 weeks were less likely to have a vaginal delivery within 24 hours (RR 0.66, 95% CI 0.45–0.96) and their babies had an increased likelihood of neonatal adverse outcomes with more NICU admissions (RR 3.56, 95% CI 1.09–11.58) and abnormal FHR patterns (RR 4.36, 95% CI 1.02–18.66) in one trial [101]. Uterine hyperstimulation was not increased.
Intrapartum Fetal Surveillance
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
It presents with FHR remaining for <30 seconds on a stable baseline and decelerates for more than 90 seconds. The fetus spends more time with a heart rate that is decelerating and only one-third of the time at baseline to exchange gases and to protect its brain. It can lead to the development of fetal acidosis with a drop in pH at a rate of 0.01 per 2–3 minutes. Once it happens, rule out the occurrence of uterine hyperstimulation, and in case it occurs in the second stage, the mother needs to stop pushing, which will help for fetal oxygenation to recover.
Amniotic Fluid Embolism
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Amniotic fluid embolism commonly occurs immediately after delivery or during labour. However, AFE has been reported as early as the second trimester and as late as a few hours following delivery. Studies have revealed minor associations with increased maternal age (>35 years), multiparity, induction or augmentation of labour with oxytocin, uterine hyperstimulation, polyhydramnios, multiple pregnancy, instrumental vaginal delivery, caesarean delivery, second-trimester miscarriage, uterine rupture, cervical lacerations, placental abruption, amniotomy and other intrauterine procedures such as amnioinfusion and amniocentesis. The connection of AFE in these conditions has been attributed to strong uterine contractions, excessive amniotic fluid or disruption of vessels supplying the uterus. However, these correlations are rather common, and the condition of AFE, in contrast, is quite rare. Therefore, for all practical purposes, AFE is neither predictable nor preventable and can occur at any time in any pregnant woman.
Moving preinduction cervical ripening to a lower acuity inpatient setting using the synthetic hygroscopic cervical dilator: a cost-consequence analysis for the United States
Published in Journal of Medical Economics, 2022
Sita J. Saunders, Jody L. Grisamore, Tess Wong, Rafael Torrejon Torres, Rhodri Saunders, Brett Einerson
Another aspect that could be added to this analysis if data were available is analgesic use during cervical ripening, as differences in analgesics may impact overall costs and staff time. The average number of administrations for oral and vaginal PGE1 may be underestimated in the base case. These numbers were taken from the IMPROVE trial where after the first 25 mcg administration, 50 mcg of PGE1 was administered. However, we identified that 25 mcg is frequently given for all administrations in the US (Supplementary material)30. Uterine hyperstimulation with and without fetal heart-rate changes have been associated with both 25 and 50 mcg doses, with higher doses associated with an increased rate of uterine hyperstimulation5. From an economic viewpoint, changing the dosage could influence the number of required administrations, which is associated with additional fetal monitoring and administration costs. A further consideration is that although fetal monitoring is standard practice in the US during cervical ripening5, and we include 30 min of continuous fetal monitoring after each administration of the SHCD in the model, this may not be required for the SHCD when L&D units become more familiar with this CRA.
Oral misoprostol tablets (25 µg) for induction of labor: a targeted literature review and cost analysis
Published in Journal of Medical Economics, 2022
Anne-Claire Poinas, Katherine Padgett, Roel de Heus, Franck Perrotin, Roland Devlieger
Misoprostol is a synthetic prostaglandin E1 analogue22. It is sold under the brand name Cytotec (Pfizer Inc, Groton, CT) and other brand names, and is indicated for the treatment of gastric and duodenal ulcers23. Misoprostol is among the options recommended by the WHO and has commonly been used off-label for IOL; however, off-label use is associated with various concerns. Cytotec is formulated as 200 µg tablets, but the dosing required for IOL is either 25 or 50 µg per dose. There is no single protocol for the preparation of the correct dose, and practitioners use differing preparation methods and dosing regimens24. Cutting up the tablet is difficult to do precisely and may lead to dosing inaccuracy25,26. Further, compounded Cytotec deteriorates rapidly and therefore has a short shelf life27. Correct misoprostol dosing is vital to ensure efficacy and safety and minimize adverse events28. Too high a dose can increase the risk of uterine hyperstimulation29, too low a dose can lead to ineffective induction30. Because of the risk of negative outcomes associated with off-label use, Cytotec has been withdrawn for all indications in France due to safety concerns23,31, and is subject to warnings and restrictions in other countries32,33.
The impact of vaginal pH on induction of labour outcomes: a meta-analysis of observational studies
Published in Journal of Obstetrics and Gynaecology, 2022
Vasilios Pergialiotis, Konstantina Papadatou, Michail Panagiotopoulos, Ioannis Bellos, Angeliki Papapanagiotou, Alexandros Rodolakis, George Daskalakis
An acidic vaginal pH did not influence the efficacy of misoprostol or dinoprostone in terms of accomplishing a successful vaginal delivery (Figure 2(a)). The interval from onset of induction to the active phase of first stage was also comparable (MD 1.21 h, 95% CI −7.06, 9.48 for misoprostol and 2.41 h, −3.88, 8.69 for dinoprostone). Similarly, the interval between induction of labour and onset of second stage was also comparable (MD 2.39 h, 95% CI −9.34, 14.11 for misoprostol and 0.99 h, 95% CI −2.41, 4.38 for dinoprostone). The overall interval from onset of induction till delivery was also comparable among the two groups (Figure 2(b)). Rates of uterine hyperstimulation were investigated in two studies only and did not differ among women with acidic and normal pH (RR 1.33, 95% CI 0.01, 204.59).