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Fetal Growth Restriction
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Juliana Gevaerd Martins, Alfred Abuhamad
There is still controversy regarding the relationship between labor induction and increased risks of cesarean section and other adverse outcomes in pregnancies complicated by FGR [216]. Previous studies have compared mechanical methods (Foley balloon) versus prostaglandins (dinoprostone and misoprostol) for cervical ripening in pregnancies complicated by late-onset FGR [216–218]. A recent systematic review and meta-analysis of 12 studies (1711 pregnancies) reported a lower rate of overall composite adverse intrapartum outcome, cesarean section for non-reassuring fetal heart tracing, uterine tachysystole and composite adverse perinatal outcomes in pregnancies induced with Foley balloon compared to dinoprostone and misoprostol [218]. Mechanical methods appear to be associated with a lower occurrence of adverse intrapartum outcome; however, the quality of the studies was low with considerable clinical and statistical heterogeneity [218].
Management Of The Uncomplicated Term Pregnancy
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
If induction for 39 weeks’ gestation is declined, induction should occur soon after the due date, and certainly by 40 weeks 5 days, or 41 weeks 0 days maximum. A policy of labor induction at 41 completed weeks (41–416/7) or beyond is associated with significantly fewer perinatal deaths (1/2814 vs. 9/2785; RR 0.30, 95% CI 0.09–0.99) compared with expectant management, with induction not before 42 weeks [21]. If deaths due to congenital abnormality are excluded, no deaths remain in the labor induction group and 11 deaths remain in the no-induction group. There were fewer cesarean sections in the induction group (RR 0.89, 95% CI 0.81–0.97). Labor induction at 41 weeks also significantly reduces the risk of perinatal meconium aspiration syndrome compared with expectant management (RR 0.50, 95% CI 0.34–0.73). Other maternal and perinatal outcomes are similar between the groups. It is important to recognize, however, that in general the outcomes are very good with both expectant management and induction, with the absolute perinatal death rate per 1000 ongoing pregnancies no higher than 1.2/1000 at 42 weeks, increasing up to 6/1000 ongoing pregnancies at 43 weeks [23]. About 410 inductions (95% CI 322–1492) would need to be done at 41 weeks in order to prevent one perinatal death [21].
Twin Delivery
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Many women with multiple pregnancy will deliver preterm, and therefore, corticosteroids should be administered after 24 weeks of gestation to improve the lung maturity of the fetus, which is threatened by preterm labour. If not, induction of labour is commonly practised with an uncomplicated dichorionic twin pregnancy at 37 weeks of gestation, and with an uncomplicated monochorionic diamniotic twin pregnancy at 36 weeks after a course of antenatal corticosteroids has been considered, due to the increased risk of intrauterine fetal demise beyond these gestations. Similar procedures for labour induction as used in a singleton pregnancy, such as insertion of vaginal prostaglandins or transcervical Foley catheter and amniotomy followed by oxytocin infusion can be used depending on the modified Bishop’s score.
Quantitative cervicovaginal fetal fibronectin as a predictor of cervical ripening and induced labour duration in late-term pregnancy
Published in Journal of Obstetrics and Gynaecology, 2023
Modupe Olatokunbo Adedeji, Ayokunle Moses Olumodeji, Adetokunbo Olusegun Fabamwo, Oyedokun Yekini Oyedele
The modified Bishop scoring system, determined on digital pelvic examination, uses the cervical length, station, dilatation, position and consistency and is widely used to determine whether or not a cervix is ‘favourable’ and to assess whether or not cervical ripening is needed (Bishop 1964, Wormer et al.2022). The Bishop score is easy to use, cost-effective and predicts vaginal delivery with a sensitivity around 75% (Bishop 1964, Wormer et al.2022). However, it is not an objective method, in that; there could be inter-observer differences in cervical assessment (Akyol et al.2007). The sensitivity of the bishop score for vaginal delivery varies widely among studies, also varying among cut-offs and populations. It also lacks good specificity and negative predictive value (Kolkman et al.2013, Hu et al.2022). Furthermore, Meier et al. systematically reviewed the literature to assess published models derived and validated to predict the success of vaginal birth following induction of labour but concluded that ‘no published model can be recommended for use at the bedside to determine the success of vaginal birth after labour induction’ (2019). Hence, a more objective tool could improve the care of women with unfavourable cervix prior to induction of labour.
Intraamniotic digoxin administration versus intracardiac or funic potassium chloride administration to induce foetal demise before termination of pregnancy: a prospective study
Published in Journal of Obstetrics and Gynaecology, 2022
Münip Akalın, Oya Demirci, Oya Gokcer, Hayal İsmailov, Ali Sahap Odacilar, Gizem Elif Dizdarogulları, Özge Kahramanoğlu, Aydın Ocal, Guher Bolat, Mucize Eriç Özdemir
For short-term obstetric outcomes, labour induction time, hospitalisation time, extramural delivery, retained conceptus product requiring curettage, and chorioamnionitis were recorded. The induction time was defined as the time from the beginning of labour induction with misoprostol to the time of delivery. The hospitalisation time was defined as the time from admission to postpartum discharge. Complete blood counts and C-reactive protein (CRP) levels were measured on the first postpartum day. Haematocrit levels before foeticide administration were compared with postpartum haematocrit levels and decreases were recorded. Chorioamnionitis was suspected if at least two of the following conditions were present: pyrexia (≥38 °C), uterine tenderness, pyogenic discharge, elevated white blood cell count, or elevated CRP level.
Effectiveness of aromatherapy in reducing duration of labour: a systematic review
Published in Journal of Obstetrics and Gynaecology, 2022
Ashraf Ghiasi, Leila Bagheri, Fatemeh Sharaflari
Prolonged labour is associated with increased risk of infection, hypoxia and perinatal death, postpartum haemorrhage or infection (Talebi et al. 2020). A broad range of pharmacological and non-pharmacological methods are typically used for labour induction and augmentation (Hall et al. 2012). A variety of methods which include stripping of the membranes, artificial rupture of membranes and pharmacologic agents, such as (prostaglandins and oxytocin) are used for induction of labour (Levine et al. 2016). However, these methods are usually associated with side effects. Therefore, in recent years, the use of non-pharmacological methods of delivery management, such as touch, aromatherapy, acupuncture, acupressure, reflexology and exercise to reduce the length of labour have become particularly popular.