The aesthetic nature of the birthing room environment may alter the need for obstetrical interventions – an observational retrospective cohort study

Abstract The concept of sensory delivery rooms was introduced in 2013. These rooms offer programmable calming lights, restful blurred pictures displayed on a wall-sized big screen, and sound effects. The primary aim of this observational study was to analyse the risk of obstetrical interventions among women giving birth for the first-time in a sensory delivery room vs. a standard delivery room. We included nulliparous, term pregnant women having a single baby with a cephalic presentation who were in spontaneous labour and gave birth between March 1st 2014 and July 1st 2015 in North Zealand Hospital, Hillerød. A total of 789 women were included in the study, 313 gave birth in a sensory room and 476 in a standard delivery room. The risk of a caesarean delivery was significantly decreased when giving birth in a sensory room compared with a standard delivery room (OR, multiple adjusted: 0.44; 95% CI 0.22–0.87); furthermore, the use of oxytocin infusion was also reduced (OR, multiple adjusted: 0.71; 95% CI 0.50–1.03). This observational cohort study suggests that giving birth in a sensory delivery room could lower the risk of caesarean delivery, potentially reducing the number of such deliveries by one for every 23 patients

Balloon catheters versus vaginal prostaglandins for labour induction (CPI Collaborative):an individual participant data meta-analysis of randomised controlled trials

Background: Induction of labour is one of the most common obstetric interventions globally. Balloon catheters and vaginal prostaglandins are widely used to ripen the cervix in labour induction. We aimed to compare the effectiveness and safety profiles of these two induction methods. Methods: We did an individual participant data meta-analysis comparing balloon catheters and vaginal prostaglandins for cervical ripening before labour induction. We systematically identified published and unpublished randomised controlled trials that completed data collection between March 19, 2019, and May 1, 2021, by searching the Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and PubMed. Further trials done before March 19, 2019, were identified through a recent Cochrane review. Data relating to the combined use of the two methods were not included, only data from women with a viable, singleton pregnancy were analysed, and no exclusion was made based on parity or membrane status. We contacted authors of individuals trials and participant-level data were harmonised and recoded according to predefined definitions of variables. Risk of bias was assessed with the ROB2 tool. The primary outcomes were caesarean delivery, indication for caesarean delivery, a composite adverse perinatal outcome, and a composite adverse maternal outcome. We followed the intention-to-treat principle for the main analysis. The primary meta-analysis used two-stage random-effects models and the sensitivity analysis used one-stage mixed models. All models were adjusted for maternal age and parity. This meta-analysis is registered with PROSPERO (CRD42020179924). Findings: Individual participant data were available from 12 studies with a total of 5460 participants. Balloon catheters, compared with vaginal prostaglandins, did not lead to a significantly different rate of caesarean delivery (12 trials, 5414 women; crude incidence 27·0%; adjusted OR [aOR] 1·09, 95% CI 0·95–1·24; I2=0%), caesarean delivery for failure to progress (11 trials, 4601 women; aOR 1·20, 95% CI 0·91–1·58; I2=39%), or caesarean delivery for fetal distress (10 trials, 4441 women; aOR 0·86, 95% CI 0·71–1·04; I2=0%). The composite adverse perinatal outcome was lower in women who were allocated to balloon catheters than in those allocated to vaginal prostaglandins (ten trials, 4452 neonates, crude incidence 13·6%; aOR 0·80, 95% CI 0·70–0·92; I2=0%). There was no significant difference in the composite adverse maternal outcome (ten trials, 4326 women, crude incidence 22·7%; aOR 1·02, 95% CI 0·89–1·18; I2=0%). Interpretation: In induction of labour, balloon catheters and vaginal prostaglandins have comparable caesarean delivery rates and maternal safety profiles, but balloon catheters lead to fewer adverse perinatal events. Funding: Australian National Health and Medical Research Council and Monash Health Emerging Researcher Fellowship.</p

Balloon Catheters Versus Vaginal Prostaglandins for Labour Induction (CPI Collaborative):An Individual Participant Data Meta-analysis of Randomised Controlled Trials

Since 2010, the rates of induction have risen in Australia (from 25% to 35%) and the United Kingdom (from 20% to 32%). This may be an indication that induction has become more acceptable among women and health providers. In women with unripe cervices, mechanical methods, such as balloon catheters, and pharmacological methods, such as vaginal prostaglandins, are commonly used for cervical ripening to induce labor. Yet, induction poses the risks of cesarean delivery (CD), as well as maternal and neonatal morbidity and mortality. Finding the optimal method to induce labor is important to reduce these risks. The aim of this study was to compare the safety and effectiveness of balloon catheters and vaginal prostaglandins for the induction of labor.This was a meta-analysis using individual patient data from published and unpublished randomized controlled trials that had completed data collection between March 19, 2019, and May 1, 2021. A recent Cochrane review provided additional trials completed before March 19. Eligible trials were those that compared single- or double-balloon catheters with the vaginal prostaglandins, misoprostol, or dinoprostone. The analysis included only women with viable, singleton pregnancies with no exclusion for parity or membrane status. The primary outcomes were CD, a composite of adverse maternal outcomes, and a composite of adverse perinatal outcomes.A total of 12 trials, representing 5460 deliveries, were included in the analysis. Overall, the crude incidence of CD was 27%, the perinatal composite was 13.6%, and the maternal composite was 22.7%. No significant differences in the rate of CD were found between patients who received a balloon catheter and those given vaginal prostaglandin to induce labor (12 trials, 5414 women; adjusted odds ratio [aOR], 1.09; 95% confidence interval [CI], 0.95–1.24). The adverse perinatal composite was lower among those who received balloon catheters (10 trials, 4452 neonates; aOR, 0.80 [95% CI, 0.70–0.92]; I2 = 0%). There were no significant differences for the adverse maternal composite measure (10 trials, 4326 women; aOR, 1.02 [95% CI, 0.89–1.18]; I2 = 0%). Balloon catheters were associated with fewer instrumental vaginal births than vaginal prostaglandins (10 trials, 4888 women; aOR, 0.82 [95% CI, 0.68–1.00]). In a subgroup analysis, there was a lower chance of the adverse perinatal composite with the use of a single-balloon catheter versus vaginal prostaglandins (9 trials, 2683 neonates; aOR, 0.84 [95% CI, 0.71–0.99]).This study found that labor induction with balloon catheters and vaginal prostaglandins was equally effective and had similar rates of CD and adverse composite maternal outcome. However, induction with a balloon catheter was observed to improve perinatal outcomes