“Early Rupture of Membranes” during Induced Labor as a Risk Factor for Cesarean Delivery in Term Nulliparas

OBJECTIVE: To determine if "early rupture of membranes" (early ROM) during induction of labor is associated with an increased risk of cesarean section in term nulliparas. STUDY DESIGN: The rate of cesarean section and the timing of ROM during the course of labor were examined in term singleton nulliparas whose labor was induced. Cases were divided into 2 groups according the timing of ROM: 1)"early ROM", defined as ROM at a cervical dilatation<4 cm during labor; and 2) "late ROM", ROM at a cervical dilatation≥4 cm during labor. Nonparametric techniques were used for statistical analysis. RESULTS: 1) In a total of 500 cases of study population, "early ROM" occurred in 43% and the overall cesarean section rate was 15.8%; 2) patients with "early ROM" had a higher rate of cesarean section and cesarean section due to failure to progress than did those with "late ROM" (overall cesarean section rate: 24%[51/215] vs. 10%[28/285], p<0.01; cesarean section rate due to failure to progress: 18%[38/215] vs. 8%[22/285], p<0.01 for each) and this difference remained significant after adjusting for confounding variables. CONCLUSION: "Early ROM" during the course of induced labor is a risk factor for cesarean section in term singleton nulliparas

Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Peer reviewe

Induction of labour with a Foley catheter or oral misoprostol at term:the PROBAAT-II study, a multicentre randomised controlled trial

<p>Background: Induction of labour is a common obstetric procedure. At present, different methods are used for induction of labour in women with an unfavourable cervix. Recently, we showed that in term women with an unfavorable cervix the use of a Foley catheter in comparison with vaginal Prostaglandin E2 gel, results in a comparable vaginal delivery rate. A meta-analysis on the subject indicated lower rates of hyperstimulation, and probably as a sequel fewer cases of postpartum haemorrhage. Misoprostol (PgE1) is another type of prostaglandin frequently used for labour induction, recommended by the international federation of gynaecology and obstetrics (FIGO). Misoprostol can be administered by vaginal, rectal and oral route. There is evidence that oral administration results in less asphyxia and hyperstimulation than vaginal administration. At present, valid comparisons between oral misoprostol and Foley catheter are lacking. Therefore, we propose a randomised controlled trial comparing Foley catheter to oral misoprostol in order to assess safety and cost-effectiveness.</p><p>Methods/Design: We plan a multicentre, randomised, controlled, open-label clinical trial among term pregnant women with a vital singleton in cephalic presentation, unfavorable cervix, intact membranes and an indication for induction of labour. After informed consent, women will be randomly allocated by a webbased randomisation system to transcervical Foley catheter or oral misoprostol (50 mcg every 4 hours). The primary outcome will be a composite of complications of uterine hyperstimulation, i.e. post partum haemorrhage and asphyxia. Secondary outcomes are mode of delivery, maternal and neonatal morbidity, costs and women's preference. Serious adverse events such as severe maternal or neonatal morbitity or mortality will be monitored and reported to an independent data safety monitory board. With a sample size of 1860 women we will be able to demonstrate a 5% non-inferiority of the Foley catheter as compared to misoprostol for the composite outcome.</p><p>Discussion: Worldwide, various methods are being used for labour induction. Results of the proposed trial will contribute to the answer which method of induction of labour is most safe, cost-effective, and patient friendly and will help to construct evidence based guidelines.</p>

The Bishop score as a determinant of labour induction success: a systematic review and meta-analysis

PURPOSE: To evaluate the association between the Bishop Score and successful induction. STUDY STRATEGY AND SELECTION CRITERIA: We searched the PubMed and the lists of references of relevant studies to identify reports on the association between Bishop Score and achieving active phase of labour or vaginal delivery. DATA COLLECTION AND ANALYSIS: We abstracted crude or adjusted measures of association from studies. Summary odds ratio (OR) and summary hazard ratio (HR), and 95 % confidence interval (95 % CI) were obtained by random effects meta-analysis. Study heterogeneity was assessed using the I (2) test. RESULTS: Fifty-nine studies met the inclusion criteria. Analyses with crude ORs showed that women with higher versus lower Bishop Score were more likely to achieve vaginal delivery either with no time limit for this to occur, or within a certain time interval; the summary ORs according to the Bishop Score cutoff ranged from 1.98 (95 % CI: 1.58-2.48; I (2) = 36.6 %) to 5.48 (95 % CI: 1.67-17.96; I (2) = 0.0 %) and from 2.15 (95 % CI: 1.36-3.40; I (2) = 0.0 %) to 4.22 (95 % CI: 2.48-7.17; I (2) = 11.0 %), respectively. Summary estimates per unit increase in the Bishop Score, based on adjusted ORs, showed a positive association with achieving vaginal delivery, either with no time limit (OR(summary) = 1.33; 95 % CI: 1.13-1.56; I (2) = 66.1 %) or within a certain time interval (OR(summary) = 1.52; 95 % CI: 1.37-1.70; I (2) = 42.4 %). Summary HRs per unit increase in Bishop Score showed an association with induction to vaginal delivery (HR(summary) = 1.28; 95 % CI: 1.21-1.36; I (2) = 0.0 %), but not with induction to active phase (HR(summary) = 1.21; 95 % CI: 0.88-1.68; I (2) = 70.7 %) time interval. CONCLUSIONS: Bishop Score seems be a determinant of achieving vaginal delivery and is associated with induction-to-vaginal delivery time interval