Search

Objective: To evaluate vaginal delivery in obese women who underwent cervical ripening at term using a dinoprostone vaginal insert or a cervical ripening balloon (CRB), and to assess maternal and neonatal morbidity according to the method., Methods: A prospective cohort study including obese women with a live singleton fetus in cephalic presentation who required cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using a dinoprostone vaginal insert or a CRB. The primary outcome was vaginal delivery. Secondary outcomes were a favorable cervix (Bishop score >6) after 24 h, the time from device insertion to delivery, and composite maternal and neonatal morbidity., Results: In total, 135 consecutive women were analyzed (107 CRB, 79.3%; 28 dinoprostone vaginal insert, 20.7%). Vaginal delivery (86 [80.4%] after CRB vs 19 [67.9%] after dinoprostone vaginal insert; P = 0.248), favorable cervix within 24 h after device placement (52 [48.6%] vs 17 [60.7%]; P = 0.264), and maternal morbidity (12 [11.2%] vs 4 [14.3%]; P = 0.646) were similar between the groups. The time from device insertion to delivery also did not differ between the groups. Neonatal morbidity was significantly higher after the dinoprostone vaginal insert (11 [39.3%] vs 20 [18.7%]; P = 0.030). Cervical ripening using the dinoprostone vaginal insert, compared with the CRB, was significantly associated with neonatal morbidity (adjusted odds ratio 4.00, 95% confidence interval 1.34-12.5), but not with maternal morbidity (adjusted odds ratio 1.23, 95% confidence interval 0.30-4.38)., Conclusions: Vaginal delivery, a favorable cervix after 24 h, the time from device insertion to delivery, and maternal morbidity did not significantly differ between the CRB and the dinoprostone vaginal insert for cervical ripening in obese women at term. Nevertheless, neonatal morbidity was significantly associated with the dinoprostone vaginal insert, compared with the CRB, among obese women who required cervical ripening at term., (© 2024 International Federation of Gynecology and Obstetrics.)

Introduction: The aim of this study was to compare vaginal dinoprostone and mechanical methods for induction of labor (IOL) in pregnancies complicated by late fetal growth restriction., Material and Methods: Multicenter, retrospective, cohort study involving six referral centers in Italy and Spain. Inclusion criteria were pregnancies complicated by late fetal growth restriction as defined by Delphi consensus criteria. The primary outcome was the occurrence of uterine tachysystole; secondary outcomes were either cesarean delivery or operative vaginal delivery for non-reassuring fetal status, a composite score of adverse neonatal outcome and admission to neonatal intensive care unit (NICU). Univariate and multivariate logistic regression analysis was used to analyze the data., Results: A total of 571 pregnancies complicated by late fetal growth restriction undergoing IOL (391 with dinoprostone and 180 with mechanical methods) were included in the analysis. The incidence of uterine tachysystole (19.2% vs. 5.6%; p = 0.001) was higher in women undergoing IOL with dinoprostone than in those undergoing IOL with mechanical methods. Similarly, the incidence of cesarean delivery or operative delivery for non-reassuring fetal status (25.6% vs. 17.2%; p = 0.027), composite adverse neonatal outcome (26.1% vs. 16.7%; p = 0.013) and NICU admission (16.9% vs. 5.6%; p < 0.001) was higher in women undergoing IOL with dinoprostone than in those undergoing IOL with mechanical methods. At logistic regression analysis, IOL with mechanical methods was associated with a significantly lower risk of uterine tachysystole (odds ratio 0.26, 95% confidence interval 0.13-0.54; p < 0.001)., Conclusions: In pregnancies complicated by late fetal growth restriction, IOL with mechanical methods is associated with a lower risk of uterine tachysystole, cesarean delivery or operative delivery for non-reassuring fetal status, and adverse neonatal outcome compared with pharmacological methods., (© 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Introduction: Induction methods are many such as intravaginal misoprostol, intracervical Foley catheter, intracervical dinoprostone, etc. Presently, a very limited number of studies are available for comparing all three popular methods intravaginal misoprostol, intracervical Foley catheter, and intracervical dinoprostone. Aims and objectives: Comparison of efficacy of pervaginal misoprostol, intracervical Foley catheter, and intracervical dinoprostone on induction of labor and fetomaternal outcome. Materials and methods: It is a prospective study conducted on 273 patients divided into 3 groups, and each group included 90 study subjects. • Group I - Foley catheter of No. 18 introduced in the cervical canal. The Foley catheter balloon is filled with 50 mL of normal saline. • Group II - Dinoprostone 2.5 mL of 0.5 mg injected into the cervical canal below the internal os under aseptic precautions. • Group III - Tablet misoprostol 25-µg pervaginally put in the posterior fornix. Continuous observation of the patients will be done in all groups. Results: Success of induction was 100% in the Foley catheter, 92.3% in dinoprostone gel, and 90% in the misoprostol group, respectively. Vaginal delivery occurred--83.51% in Foley catheter, 59.34% in dinoprostone gel, and 73.62% in the misoprostol groups, respectively. The mean induction to delivery interval time was 16.78 ± 6.5 hours in the Foley catheter group, 12.87 ± 6.41 hours in the dinoprostone gel group, and 11.16 ± 5.97 in the misoprostol group. Conclusion: Foley catheter is superior to dinoprostone gel and misoprostol in achieving vaginal delivery. [ABSTRACT FROM AUTHOR]

Objectives: Labor induction is one of the most common procedures in modern obstetrics. One in five pregnant women and 30-40% of women delivering vaginally undergo this procedure. If the cervical status is unfavorable, a ripening process is used prior to induction to shorten the duration of oxytocin administration and maximize the possibility of vaginal birth. The aim of this study was to compare the duration of labor induced with dinoprostone vaginal insert to spontaneous labor. Material and methods: It was a retrospective study conducted between May 2019 and February 2021 in the tertiary reference center, the Obstetrics and Perinatology Department of the Jagiellonian University Hospital in Krakow. The research group involved 182 patients in singleton pregnancy at term, qualified for cervical ripening procedure. The control group consisted of 178 patients that were delivering spontaneously and admitted to the delivery ward in the first stage of labor. Statistical analysis was performed to compare the duration of labor between groups. To find factors affecting the procedure we compared different models consisting of maternal and fetal characteristics. Results: Successful vaginal delivery in the dinoprostone group was achieved in the group of 88% of patients. There was no significant difference in labor duration between the groups: 315 minutes in the study group and 300 min in the control group. Only being primipara was a factor related to longer labor in both groups. Conclusions: Pre-induction with dinoprostone insert and additional foley catheter, if indicated, does not make labor longer in comparison with spontaneous labor. [ABSTRACT FROM AUTHOR]

Plain language summary: Increasingly, births around the world are started artificially using medications or other methods. This process is known as induction of labour. As it becomes more common, methods are needed to meet the different clinical needs and birth preferences of women. Induction of labour typically includes a combination of the medication dinoprostone inserted into the vagina, artificial rupture of membranes ('releasing the waters'), and synthetic oxytocin (hormone given via a drip). This paper reviews some of the methods less commonly used for induction in the UK, namely a drug called misoprostol, which can be given orally or vaginally, and 'mechanical' methods, where labour is started by stretching the cervix (neck of the womb), most commonly with a soft silicone tube with a balloon near the tip, filled with water. Low‐dose oral misoprostol tablets are now commercially available in the UK. Other methods for labour induction are not reviewed in detail in this paper. The evidence suggests mechanical induction of labour (using a balloon catheter) and misoprostol are both at least as safe and effective as using the standard drug, dinoprostone. There is evidence to suggest a balloon catheter may reduce the chance of serious negative outcomes for babies when compared with dinoprostone, and that giving low‐dose oral misoprostol results in fewer caesarean births. Where possible and after informed consent, the method of induction of labour should be personalised to suit the individual woman, her clinical condition, and the setting in which she is giving birth. Local contexts and resources also need to be taken into account. To date, research into women's perspectives and experiences of induction of labour have been significantly lacking. [ABSTRACT FROM AUTHOR]