Induction of labor and nulliparity: A nationwide clinical practice pilot evaluation.

IntroductionInduction of labor has become an increasingly common obstetric procedure, but in nulliparous women or women with a previous cesarean section, it can pose a clinical challenge. Despite an overall expansion of medical indications for labor induction, there is little international consensus regarding the criteria for induction, or for the recommended methods among nulliparous women. In this light, we assessed variations in the practice of induction of labor among 21 birth units in a nationwide cohort of women with no prior vaginal birth.Material and methodsWe carried out a prospective observational pilot study of women with induced labor and no prior vaginal birth, across 21 Norwegian birth units. We registered induction indications, methods and outcomes from 1 September to 31 December 2018 using a web-based case record form. Women were grouped into "Nulliparous term cephalic", "Previous cesarean section" and "Other Robson" (Robson groups 6, 7, 8 or 10).ResultsMore than 98% of eligible women (n=1818) were included and a wide variety of methods was used for induction of labor. In nulliparous term cephalic pregnancies, cesarean section rates ranged from 11.1% to 40.6% between birth units, whereas in the previous cesarean section group, rates ranged from 22.7% to 67.5%. The indications "large fetus" and "other fetal" indications were associated with the highest cesarean rates. Failed inductions and failure to progress in labor contributed most to the cesarean rates. Uterine rupture occurred in two women (0.11%), both in the previous cesarean section group. In neonates, 1.6% had Apgar ConclusionsCesarean rates and applied methods for induction of labor varied widely in this nationwide cohort of women without a prior vaginal birth. Neonatal outcomes were similar to those of normal birth populations. Results could indicate the need to move towards more standardized induction protocols associated with optimal outcomes for mother and baby

En sammenligning av Misoprostol vaginalinnlegg og Misoprostol tabletter for fødselsinduksjon blant førstegangsfødende kvinner: En retrospektiv kohortstudie.

Introduksjon: Formålet med studien var å sammenligne Misoprostol vaginalinnlegg (MVI) med Misoprostol tabletter med tanke på hvor effektive og trygge medikamentene er ved fødselsinduksjon. Materiale og metode: Denne retrospektive kohortstudien inkluderte 171 førstegangsfødende, med ett barn i hodeleie, til termin, og som ble indusert med enten 200 μg MVI (n=85) eller 25 μg Misoprostol tabletter (n=86). Hovedutfallene var tid fra medikamentstart til fødsel og andelen sectio. Resultat: Tid fra medikamentstart til fødsel var gjennomsnittlig 6 timer og 13 minutter kortere i MVI-gruppen (p=0.001), sammenlignet med Misoprostol tablett-gruppen. Andelen sectio var lavere i MVI-gruppen enn i Misoprostol tablett-gruppen, justert OR=0.31 (95 % KI; 0.11-0.92). Konklusjon: Resultatene i denne studien viste at MVI var mer effektivt og tryggere enn Misoprostol tabletter ved fødselsinduksjon. Det er imidlertid ikke publisert andre studier som sammenligner de to medikamentene, mer forskning trengs

A comparison of misoprostol vaginal insert and misoprostol vaginal tablets for induction of labor in nulliparous women: a retrospective cohort study

Abstract Background Since Misoprostol Vaginal Insert (MVI - Misodel ®) was approved for labor induction in Europe in 2013, to date, no study has been published comparing MVI to Misoprostol vaginal tablets (MVT). The aim of this study, performed as part of a quality improvement project, was to compare the efficacy and safety of 200 μg MVI versus 25 μg MVT for labor induction in nulliparous women. Methods This retrospective cohort study included 171 nulliparous singleton term deliveries induced with MVI (n = 85) versus MVT (n = 86) at Oslo University Hospital Rikshospitalet, Norway, from November 2014 to December 2015. Primary outcomes were time from drug administration to delivery in hours and minutes and the rate of cesarean section (CS). Results were adjusted for Bishop Score and pre-induction with balloon catheter. Results Median time from drug administration to delivery was shorter in the MVI group compared to the MVT group (15 h 43 min versus 19 h 37 min, p = 0.011). Adjusted for confounding factors, mean difference was 6 h 3 min (p = 0.002). The risk of CS was 67% lower in the MVI group compared to the MVT group (11.8% versus 23.3%, OR = 0.33; adjusted 95% CI 0.13–0.81). Adverse neonatal outcomes did not differ between the groups. Conclusions In a setting of routine obstetric care, MVI seems to be a more efficient labor induction agent than MVT, and with a lower CS rate and no increase in adverse infant outcomes