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Background: Induction of labour (IOL) is common practice and different methods carry different effectiveness and safety profiles., Objectives: To compare the effectiveness, and maternal and perinatal safety outcomes of IOL with vaginal misoprostol versus vaginal dinoprostone using individual participant data from randomised clinical trials., Search Strategy: The following databases were searched from inception to March 2023: CINAHL Plus, ClinicalTrials.gov, Cochrane Pregnancy and Childbirth Group Trial Register, Ovid Embase, Ovid Emcare, Ovid MEDLINE, Scopus and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP)., Selection Criteria: Randomised controlled trials (RCTs), with viable singleton gestation, no language restrictions, and all published and unpublished data., Data Collection and Analysis: An individual participant data meta-analysis was carried out., Main Results: Ten of 52 eligible trials provided individual participant data, of which two were excluded after checking data integrity. The remaining eight trials compared low-dose vaginal misoprostol versus dinoprostone, including 4180 women undergoing IOL, which represents 32.8% of all participants in the published RCTs. Of these, 2077 were assigned to low-dose vaginal misoprostol and 2103 were assigned to vaginal dinoprostone. Compared with vaginal dinoprostone, low-dose vaginal misoprostol had a comparable rate of vaginal birth. Composite adverse perinatal outcomes did not differ between the groups. Compared with vaginal dinoprostone, composite adverse maternal outcomes were significantly lower with low-dose vaginal misoprostol (aOR 0.80, 95% CI 0.65-0.98, P = 0.03, I 2  = 0%)., Conclusions: Low-dose vaginal misoprostol and vaginal dinoprostone for IOL are comparable in terms of effectiveness and perinatal safety. However, low-dose vaginal misoprostol is likely to lead to a lower rate of composite adverse maternal outcomes than vaginal dinoprostone., (© 2024 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Introduction: When women with a previous cesarean section and an unfavorable cervix have an indication for delivery, the choice is to induce labor or to perform a cesarean section. This study aims to assess the effectiveness and safety of a balloon catheter as a method of induction of labor in women with one previous cesarean section and an unfavorable cervix compared with an elective repeat cesarean section., Material and Methods: We performed a prospective cohort study in 51 hospitals in the Netherlands on term women with one previous cesarean section, a live singleton fetus in cephalic position, an unfavorable cervix and an indication for delivery. We recorded obstetric, maternal and neonatal characteristics. We compared the outcome of women who were induced with a balloon catheter with the outcome of women who delivered by elective repeat cesarean section. Main outcomes were maternal and neonatal morbidity. Mode of delivery was a secondary outcome for women who were induced. Adjusted odds ratios (aOR) were calculated using logistic regression, adjusted for potential confounders., Results: Analysis was performed on 993 women who were induced and 321 women who had a repeat cesarean section (August 2011 until September 2012). Among the women who were induced, 560 (56.4%) delivered vaginally and 11 (1.1%) sustained a uterine rupture. Composite adverse maternal outcome (uterine rupture, severe postpartum hemorrhage or postpartum infection) occurred in 73 (7.4%) in the balloon and 14 (4.5%) women in the repeat cesarean section group (aOR 1.58, 95% confidence interval [CI] 0.85-2.96). Composite adverse neonatal outcome (Apgar score <7 at 5 minutes or umbilical pH <7.10) occurred in 57 (5.7%) and 10 (3.2%) neonates, respectively (aOR 1.40, 95% CI 0.87-3.48). Women who were induced had a shorter postpartum admission time (2.0 vs 3.0 days (P < 0.0001))., Conclusions: In women with a previous cesarean section and a need for delivery, induction of labor with a balloon catheter does not result in a significant increase in adverse maternal and neonatal outcomes as compared with planned cesarean section., (© 2019 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).)

Background: The influence of ethnicity in women with gestational diabetes in relation to maternal, pregnancy and neonatal outcome is not well defined., Aim: To compare the perinatal outcome in women with gestational diabetes between different ethnic groups reflecting the multi-ethnic population in the Netherlands., Methods: Patients with gestational diabetes (n = 388) who visited the multidisciplinary outpatient clinic for Diabetes Care and Obstetrics of the Sint Franciscus Gasthuis in Rotterdam between 2010 and 2013 were included. Ethnicity was distinguished into six groups: Moroccan (n = 100); Turkish (n = 43); Caucasian (n = 146); Suriname-Creole (n = 23); Suriname-Hindu (n = 32); and Miscellaneous (n = 44)., Results: Caucasians were the largest group with gestational diabetes (37.7%), followed by Moroccans (25.8%). Body mass index before pregnancy was highest in Surinamese-Creole women, followed by Turks and Moroccans (p &lt; 0.001). Gravidity and parity were highest in Moroccans. Gravidity was lowest in Surinamese-Hindus and parity was lowest in Caucasians (p &lt; 0.001). There was also a remarkable, significant difference in the mode of delivery between the ethnicities with the lowest number of normal deliveries in Caucasians and the highest in Moroccans (p = 0.03). Assisted delivery occurred most frequently in Caucasian women, although there was no difference in the frequency of caesarean sections. Birth weight was the only neonatal parameter showing significant differences between the ethnicities, with the highest birth weight for Moroccan children and the lowest for Surinamese children (3542 g vs. 3200; p = 0.001)., Conclusion: This study did not show major differences in maternal or neonatal complications, however there are significant disparities in (percentile) birth weight and mode of delivery across the different ethnic groups.

Background: Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can be distinguished by location, morphology and extent of cutaneous and mucosal lesions. EM has minimal effects on pregnancy and the genital tract. SJS and TEN on the other hand are related with premature labor and vaginal scarring that can lead to long-term painful lesions, stenosis, vaginal adenosis and telangiectasia., Case: A 33-year-old G3P2 with a medical history of SJS has multiple recurrences during pregnancy of what seems to be EM instead of SJS with a favorable outcome., Conclusion: Differentiation between EM, SJS and TEN is important in gynecology to predict the effects of the diseases on the genital tract and on pregnancy.

Objective: To compare vaginal misoprostol with dinoprostone for induction of labour., Design: Randomised multicentre trial., Setting: Labour wards of one university hospital and two teaching hospitals., Population: Six hundred and eighty-one women with indication for labour induction at >or=36 weeks of gestation, singleton pregnancy and no previous ceasarean section., Methods: Misoprostol (25 mcg, hospital-prepared capsule) in the posterior vaginal fornix, every four hours, maximum three times daily or dinoprostone gel (1 mg) every four hours. Oxytocin was administered if necessary., Main Outcome Measures: Primary: 'adverse neonatal outcome' (5-minute Apgar score <7 and/or umbilical cord pH <7.15). Secondary: labour duration, mode of delivery and patient satisfaction., Results: Three hundred and forty-one women received misoprostol and 340 dinoprostone. The median induction-delivery interval was longer in the misoprostol group compared with the dinoprostone group (25 versus 19 hours, P= 0.008). The caesarean section rate was lower in the misoprostol group: 16.1%versus 21%, but this difference was not statistically significant RR = 0.8 (95% CI 0.6-1.04). 'Adverse neonatal outcome' was found to be similar in both groups: 21% in the misoprostol and 23% in the dinoprostone groups. Significantly fewer neonates were admitted to NICU in the misoprostol group compared with dinoprostone 19%versus 26% (RR = 0.7, 95% CI 0.5-0.98)., Conclusions: Misoprostol in this dosing regimen is a safe method of labour induction. NICU admission rates were lower in the misoprostol group. No difference could be detected in patient satisfaction between groups.

Condensation: Sulprostone, used in a continuous low-dose intravenously, is effective for pregnancy termination. Caution is necessary when using this drug in severely preeclamptic patients., Objective: To evaluate the safety and efficacy of induction of labor with a prostaglandin analogue in women with severe (pre-) eclampsia., Study Design: A retrospective analysis of a 12-year cohort in which labor was induced in women with severe (pre-) eclampsia with sulprostone (a prostaglandin E2 analogue) in a continuous intravenous low-dose intravenous dose of 1 microg/min., Results: In 30 severely preeclamptic and one eclamptic women, labor was induced on maternal indication with sulprostone. The median gestational age at induction was 28 weeks (range 16-37 weeks). The fetuses were either dead (n=19) or considered not viable (n=12). All women delivered vaginally after a median induction-expulsion interval of 14 hr (range 6-57 hr). In all but one woman, a delivery was achieved within 37 hr. Two of the nine women who suffered dyspnea at the time induction was started, experienced deterioration during infusion of sulprostone. In one of these women, infusion had to be discontinued after 2 hr and the pregnancy was terminated by dilatation and evacuation. One woman gave birth after 57 hr of sulprostone infusion. We did not observe any cardiovascular complications. All but one woman recovered after pregnancy termination: a severely eclamptic woman died 10 days after delivery, after developing adult respiratory distress syndrome, sepsis and multiple organ failure., Conclusion: Sulprostone, in a continuous low-dose intravenously, is effective for termination of pregnancy in the critically ill preeclamptic woman. Our study, including two patients with serious deterioration of pulmonary function during and one maternal death after induction, does not permit definitive conclusions regarding the safety in these patients.

Objective: The purpose of this study is to assess the effectiveness and safety of sulprostone (nalador) for labour induction in the event of foetal death or foetal malformations., Study Design: Retrospective analysis of 284 women with intrauterine foetal death (n=137), or foetal abnormalities (n=147), who underwent labour induction with sulprostone in a continuous dose of 1microg/min intravenously., Results: All but three women had a successful vaginal delivery. The median induction-expulsion interval was significantly shorter (12h) in the foetal death group compared to the foetal malformation group (25h). Two uterine ruptures were recorded, one in a woman with a uterine anomaly, and one in a woman with a previous caesarean section. There were no other complications. Gestational age had a significant influence on spontaneous expulsion of the placenta: before 24 weeks 55%, and after 24 weeks 82% spontaneous expulsion. For the chance of a neonate born with signs of life, parity was the only significant determinant., Conclusions: The use of intravenous sulprostone in a low continuous dose is both effective and safe. In addition, this study does not support former opinions that smoking and advanced maternal age are contraindications.