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Induction Of Labor
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Induction of labor is the stimulation of uterine contractions prior to spontaneous labor in order to achieve childbirth. Cervical ripening is a process that occurs prior to labor in which the cervix is softened, thinned, and dilated.
Cephalopelvic Disproportion and Contracted Pelvis
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
In a woman undergoing induction of labour, one must ensure a mature cervix with a good Bishop score. Cervical ripening agents should be used with caution. Mechanical dilators like Foley catheter should be properly inserted to prevent converting the cephalic presentation to oblique or transverse lie and prevent cord prolapse from occurring.
Cervical insufficiency
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Sonia S. Hassan, Roberto Romero, Francesca Gotsch, Lorraine Nikita, Tinnakorn Chaiworapongsa
The main function of the uterine cervix is to serve as a barrier to the expulsion of the conceptus. The endocervical glands generate mucous, which forms the mucous plug, an anatomical and biochemical barrier to microorganisms. “Cervical ripening” is a term used to describe the changes in cervical dilatation, effacement, and consistency, which generally precede the onset of spontaneous labor. This process is associated with complex changes in the extracellular matrix aimed at increasing cervical compliance. The conventional view has been that uterine contractions lead to cervical change, a concept based on the relationship between increased uterine contractility and cervical dilatation during spontaneous labor at term. However, the process of cervical ripening begins weeks before the onset of labor. Similarly, preterm cervical ripening can occur without a demonstrable increase in uterine contractility. Experimental evidence indicates that cervical changes can occur even if the cervix is transected from the myometrium; therefore, these two components of the uterus (fundus and cervix) can undergo changes in the preparation for labor, which are independent from each other.
Role of sex hormones in cervical changes in a cervical excision-related preterm delivery mouse model
Published in Journal of Obstetrics and Gynaecology, 2021
Ki Hoon Ahn, Hee Youn Kim, Geum Joon Cho, Soon Cheol Hong, Min Jeong Oh, Hai Joong Kim
A prolonged muscular contraction in the proximal cervix may decrease the contractile force, resulting in relaxation (Yin et al. 2012), also known as ‘muscle fatigue’ (Pagala et al. 2006). Additionally, increased expression and activity of matrix metalloproteinase, which degrades the extracellular matrix in the proximal cervix via increased ER activity, may aggravate the weakened internal cervical orifice (Yin et al. 2012). Such early relaxation of the proximal cervix together with remodelling the cervical extracellular matrix may lead to premature birth (Figure 6; Vink et al. 2016). This is supported by previous studies reporting that abnormal cervical deformation, termed funnelling (membranes slipping into the inner canal), is a pathologic condition related to a prematurely shortened cervix (Myers et al. 2015). Cervical ripening and dilation begin near the internal cervical os (Mitchell and Wong 1993).
Outpatient cervical ripening in a district general hospital: a five-year retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2018
Lauren Barnfield, Edmund Neale, Sarah Reynolds
We believe that our study, which contains the largest number of patients undergoing cervical ripening as outpatients in published literature, therefore, supports the conclusions from our previous paper published in 2002, and our local audits conducted over the past 18years: that in a unit with good communication between women, midwives and obstetricians, and with appropriate case selection, outpatient cervical ripening as a prelude to induction of labour may be carried out safely with no additional risks to mother or baby. Overall, this study has demonstrated comparable results to those originally presented in 2002 (Neale et al. 2002) (see Tables 1 and 2) with slight variation in maternal outcomes, which may be explained by a higher proportion of multiparous women in the original report, as well as nationally increasing rates of operative delivery. We have not amended our clinical process over the last 18years, so combining the two studies we conclude that the expected rate of adverse outcomes did not seem to be increased in the 602 women admitted for outpatient cervical ripening.
A safety review of medications used for labour induction
Published in Expert Opinion on Drug Safety, 2018
Lili Sheibani, Deborah A. Wing
Despite years of research and well-conducted studies, the ideal agent is yet to be identified. Additionally, the physiology behind initiation and sustained labor needs to be understood more clearly. There is wide variation among women in normal labor and management of labor induction therefore studying new agents is challenging. Although there are well-conducted studies comparing directly approaches for cervical ripening, the data regarding the actual methods that offer the most effective/safest profile is still lacking. These studies are certainly difficult to conduct given the variation in indications used for induction of labor, parity of women, initial Bishop score at induction, along with the many other demographic factors that can affect the results of these studies. A large randomized trial to directly compare these agents in all aspects: efficacy, safety, patient satisfaction, and cost are needed but the logistics to conducting such a study make it nearly impossible.