Review of Evidence-Based Methods for Successful Labor Induction.
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ABSTRACT:
SUBMITTER: Carlson N
PROVIDER: S-EPMC8363560 | biostudies-literature | 2021 Jul
REPOSITORIES: biostudies-literature
Publications
Review of Evidence-Based Methods for Successful Labor Induction.
Carlson Nicole N Ellis Jessica J Page Katie K Dunn Amore Alexis A Phillippi Julia J
Journal of midwifery & women's health 20210513 4
Induction of labor is increasingly a common component of the intrapartum care. Knowledge of the current evidence on methods of labor induction is an essential component of shared decision-making to determine which induction method meets an individual's health needs and personal preferences. This article provides a review of the current research evidence on labor induction methods, including cervical ripening techniques, and contraction stimulation techniques. Current evidence about expected dura ...[more]
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Project description:BackgroundNegative childbirth experience may affect mother wellbeing and health. However, it is rarely evaluated in studies comparing methods of induction of labor (IoL).AimTo compare women's experience of IoL according to the method, considering the mediating role of interventions and complications of delivery.MethodsWe used data from the MEDIP prospective population-based cohort, including all women with IoL during one month in seven French perinatal networks. The experience of IoL, assessed at 2 months postpartum, was first compared between cervical ripening and oxytocin, and secondarily between different cervical ripening methods. Mediation analyses were used to measure the direct and indirect effects of cervical ripening on maternal experience, through delivery with interventions or complications.FindingsThe response rate was 47.8% (n = 1453/3042). Compared with oxytocin (n = 541), cervical ripening (n = 910) was associated less often with feelings that labor went 'as expected' (adjusted risk ratio for the direct effect 0.78, 95%CI [0.70-0.88]), length of labor was 'acceptable' (0.76[0.71-0.82]), 'vaginal discomfort' was absent (0.77[0.69-0.85]) and with lower global satisfaction (0.90[0.84-0.96]). Interventions and complications mediated between 6 and 35% of the total effect of cervical ripening on maternal experience. Compared to the dinoprostone insert, maternal experience was not significantly different with the other prostaglandins. The balloon catheter was associated with less pain.DiscussionCervical ripening was associated with a less positive experience of childbirth, whatever the method, only partly explained by interventions and complications of delivery.ConclusionCounselling and support of women requiring cervical ripening might be enhanced to improve the experience of IoL.
| S-EPMC8442398 | biostudies-literature
Project description:ObjectiveTo evaluate the effectiveness of four commonly used induction methods.MethodsThis randomized trial compared four induction methods: misoprostol alone, Foley alone, misoprostol-cervical Foley concurrently, and Foley-oxytocin concurrently. Women undergoing labor induction with full-term (37 weeks of gestation or greater), singleton, vertex-presenting gestations, with no contraindication to vaginal delivery, intact membranes, Bishop score 6 or less, and cervical dilation 2 cm or less were included. Women were enrolled only once during the study period. Our primary outcome was time to delivery. Neither patients nor health care providers were blinded to assigned treatment group because examinations are required for placement of all methods; however, research personnel were blinded during data abstraction. A sample size of 123 per group (n=492) was planned to compare the four groups pairwise (P≤.008) with a 4-hour reduction in delivery time considered clinically meaningful.ResultsFrom May 2013 through June 2015, 997 women were screened and 491 were randomized and analyzed. Demographic and clinical characteristics were similar among the four treatment groups. When comparing all induction method groups, combination methods achieved a faster median time to delivery than single-agent methods (misoprostol-Foley: 13.1 hours, Foley-oxytocin: 14.5 hours, misoprostol: 17.6 hours, Foley: 17.7 hours, P<.001). When censored for cesarean delivery and adjusting for parity, women who received misoprostol-Foley were almost twice as likely to deliver before women who received misoprostol alone (hazard ratio 1.92, 95% confidence interval [CI] 1.42-2.59) or Foley alone (hazard ratio 1.87, 95% CI 1.87 1.39-2.52), whereas Foley-oxytocin was not statistically different from single-agent methods.ConclusionAfter censoring for cesarean delivery and adjusting for parity, misoprostol-cervical Foley resulted in twice the chance of delivering before either single-agent method.Clinical trial registrationClinicalTrials.gov, https://clinicaltrials.gov, NCT01916681.
| S-EPMC5127406 | biostudies-literature
Project description:BackgroundTo evaluate the effect of dexamethasone administration on the interval between initiation of labor induction and active phase of labor.MethodsThe databases including PubMed, Cochrane Library, Embase, Scopus and Web of Science were searched for studies published up to June 27, 2021. Two types of articles were included: a) full-text articles published in English or any other languages, and b) Randomized Controlled Trials (RCTs). Participants were primi- or multigravida women with term or post-term pregnancy. The intervention group received parenteral or extra-amniotic dexamethasone whereas the control group received normal saline or no treatment before initiation of labor induction. All data were analyzed using Review Manager 5.3.ResultsSeventeen studies involving 1879 patients were included in the meta-analysis. Administration of dexamethasone reduced the interval between the initiation of labor induction and the beginning of active phase by about 70 min [MD: - 1.17 (- 1.37, - 1.00); P < 0.00001]. Duration of the first stage of labor in the dexamethasone group was about 88 min shorter than that in the control. There were no maternal and fetal adverse effects.ConclusionsDexamethasone could significantly reduce the length of induction-active phase interval, and length of the first stage of labor, with no difference in maternal or fetal adverse effects.
| S-EPMC8369774 | biostudies-literature
Project description:ObjectiveTo study the association between the method of induction of labor (IOL) and perinatal outcomes, among women undergoing labor after cesarean (LAC) with no prior vaginal delivery.MethodA retrospective study including all women with no prior vaginal delivery undergoing IOL for LAC between March 2011 and January 2021. Oxytocin administration following prelabor rupture of membranes (PROM), oxytocin administration only, extra-amniotic balloon, and amniotomy were compared.ResultsOverall, 363 women met the inclusion criteria: extra-amniotic balloon (157, 43.3%), oxytocin following PROM (95, 26.2%), amniotomy (72, 19.8%), and oxytocin (39, 10.7%). LAC success rate did not differ among study groups (P = 0.114), varying between 62.1% and 79.5%. There were three uterine ruptures (0.8%) in the entire cohort. The rate of uterine rupture, postpartum hemorrhage, and the composite of both were similar in all study groups. Neonatal outcomes did not differ between study groups, with composite adverse neonatal outcomes varying between 7.4% in the oxytocin following PROM to 1.9% in the extra-amniotic balloon group (P = 0.141). The following factors were independently associated with LAC success: taller maternal height, lower body mass index, earlier gestational age, and epidural analgesia.ConclusionsAll examined IOL methods with an unfavorable cervix carried similar outcomes. The clinical practice should be individualized.
| S-EPMC10084373 | biostudies-literature
Project description:BackgroundTo identify the effectiveness of different teaching modalities on student evidence-based practice (EBP) competency.MethodsElectronic searches were conducted in MEDLINE, Cochrane central register of controlled trials, PsycINFO, CINAHL, ERIC, A + Education and AEI through to November 2021. We included randomised-controlled trials comparing EBP teaching modes on EBP knowledge, skills, attitudes or behaviour in undergraduate and post-graduate health professions education. Risk of bias was determined using the Cochrane risk of bias tool.ResultsTwenty-one studies were included in the review. Overall, no single teaching modality was identified as being superior to others at significantly increasing learner competency in EBP. Changes in learner knowledge, skills, attitudes and behaviour were conflicting, with studies either reporting no change, or a moderate increase in EBP behavioural outcomes when directly compared to another intervention.ConclusionCurrent evidence highlights the lack of a single teaching modality that is superior than others regarding learner competency in EBP, regardless of health professions discipline or graduate status. The poor quality, heterogeneity of interventions and outcome measures limited conclusions. Further research should focus on the development of high-quality studies and use of psychometrically validated tools to further explore the impact of different EBP teaching modalities.
| S-EPMC9607697 | biostudies-literature
Project description:BackgroundThe occurrence of failed induction led to higher rates of health problems and death among mothers, mainly as a result of complications related to cesarean delivery, such as postpartum bleeding, morbidly adherent placenta and surgical site infection. Even though a systematic review and meta-analysis were done before July 2020 with limited studies, there were varies inconsistent studies after that and no updated summarize evidence about the issue as a nation. Therefore, this systematic review and meta-analysis aimed to assess the current pooled prevalence of failed induction and its associated factors in Ethiopia by including multiple inconsistent studies.MethodsComprehensive literature was searched in PubMed, Google Scholar, and HINARI from January 1, 2013, to September 23, 2023. A random effect model was used to estimate pooled prevalence and adjusted odds ratio. Stata (version17.0) was used to analyze the data. Cochrane Q-test and I squared statistics were computed to assess heterogeneity among studies. A sub group analysis was done based on study region to minimize underling heterogeneity. Funnel plot and Eggers test were done to assess publication bias and corrected by trim and fill analysis.ResultOverall, one thousand fifty-two articles were retrieved and finally twenty-eight studies were included in this systematic review, including 9757 participants. The pooled prevalence of failed induction of labor was 22.39% (95% CI: 21.57-23.21). Subgroup analysis showed that failed induction of labor was highest in Addis Ababa and lowest in Tigray region. Rural residence (AOR = 3.31, 95% CI: 2.39-4.57), nullipara women (AOR = 2.63, 95% CI: 2.14-3.24), unfavorable bishop score (AOR = 3.98, 95% CI: 2.19-7.08), hypertensive disorder during pregnancy (AOR = 3.63, 95% CI: 2.69-5.01) and premature rupture of membranes before the onset of labor (AOR = 2.51, 95% CI: 1.5-4.26) were significantly associated with failed induction of labor.ConclusionThe pooled prevalence of failed induction of labor in Ethiopia was high. Unfavorable bishop score, nulliparous, rural residence, women who had premature rupture of membrane and hypertensive disorder during pregnancy were significantly associated with failed induction of labor. Therefore, Healthcare providers or obstetricians should consider proper cervical assessment for bishop score before the initiation of induction. The Ministry of Health ought to create a distinct set of guidelines specifically addressing the cervical ripening and/or induction protocol for women who experienced premature rupture of membranes (PROM) and had a hypertensive disorder during pregnancy, especially those who were administered magnesium sulfate (MgSO4).
| S-EPMC11567538 | biostudies-literature
Project description:IntroductionUse of labor induction has increased rapidly in most middle- and high-income countries over the past decade. The reasons for the stark rise in labor induction are largely unknown. We aimed to assess the extent to which the rising rate of labor induction is explained by changes in rates of underlying indications over time.Material and methodsThe study was based on nationwide data from the Icelandic Medical Birth Register on 85 620 singleton births from 1997 to 2018. The rate of labor induction and indications for induction was calculated for all singleton births in 1997-2018. Change over time was expressed as relative risk (RR), using Poisson regression with 95% confidence intervals (CI) adjusted for maternal characteristics and indications for labor induction.ResultsThe crude rate of labor induction rose from 12.5% in 1997-2001 to 23.9% in 2014-2018 (crude RR = 1.91, 95% CI 1.81-2.01). While adjusting for maternal characteristics had little impact, adjusting additionally for labor induction indications lowered the RR to 1.43 (95% CI 1.35-1.51). Induction was increasingly indicated from 1997-2001 to 2014-2018 by gestational diabetes (2.4%-16.5%), hypertensive disorders (7.0%-11.1%), prolonged pregnancy (16.2%-23.7%), concerns for maternal wellbeing (3.2%-6.9%) and maternal age (0.5%-1.2%). No indication was registered for 9.2% of inductions in 2014-2018 compared with 16.3% in 1997-2001.ConclusionsOur results show that the increase in labor induction over the study period is largely explained by an increase in various underlying conditions indicating labor induction. However, indications for 9.2% of labor inductions remain unexplained and warrant further investigation.
| S-EPMC9812102 | biostudies-literature
Project description:IntroductionObesity is an increasing public health concern worldwide and can lead to more complications in pregnancy and childbirth. Women with obesity more often require induction of labor for various indications. The aim of this study is to assess which method of induction of labor is safest and most effective in women with obesity.Material and methodsThis is a secondary analysis of two randomized controlled trials about induction of labor. Women with a term singleton pregnancy in cephalic presentation, an unfavorable cervix, intact membranes and without a previous cesarean section were randomly allocated to cervical priming with a Foley catheter or vaginal prostaglandin-E2-gel (PROBAAT-I) or a Foley catheter or oral misoprostol (PROBAAT-II). The inclusion and exclusion criteria for the studies were identical. Induction methods were compared in women with obesity (body mass index ≥30.0). Main outcomes were cesarean section and postpartum hemorrhage (blood loss >1000 mL).ResultsA total of 2664 women, were included in the trials, 517 of whom were obese: 254 women with obesity received a Foley catheter, 176 oral misoprostol and 87 prostaglandin E2 (PGE2). A cesarean section was performed in 29.1% of women allocated to Foley vs 22.2% in the misoprostol and 23.0% in the PGE2 groups. Comparisons between groups revealed no statistically significant differences: the relative risk [RR] was 1.31 (95% confidence interval [CI] 0.94-1.84) in the Foley vs misoprostol group and 1.27 (95% CI 0.83-1.95) in the Foley vs PGE2 group. The rates of postpartum hemorrhage were comparable (10.6%, 11.4% and 6.9%, respectively; P = 0.512). In women with obesity, more often a switch to another method occurred in the Foley group, (20.1% vs 6.3% in misoprostol vs 1.1% in the PGE2 group; P < 0.001). The risk of a failed Foley placement was higher in women with obesity than in women without obesity (8.3% vs 3.2%; adjusted odds ratio 3.12, 95% CI 1.65-5.90).ConclusionsIn women with obesity we found a nonsignificant trend towards an increased rate of cesarean sections in the group induced with a Foley catheter compared to oral misoprostol; however, the study lacked power for this subgroup analysis. The finding of a higher risk of failed placement of a Foley catheter in women with obesity can be used in shared decision making.
| S-EPMC10867363 | biostudies-literature
Project description:Approximately 1 in 4 pregnant women in the United States undergo labor induction. The onset and establishment of labor, particularly induced labor, is a complex and dynamic process influenced by multiple endocrine, inflammatory, and mechanical factors as well as obstetric and pharmacological interventions. The duration from labor induction to the onset of active labor remains unpredictable. Moreover, prolonged labor is associated with severe complications for the mother and her offspring, most importantly chorioamnionitis, uterine atony, and postpartum hemorrhage. While maternal immune system adaptations that are critical for the maintenance of a healthy pregnancy have been previously characterized, the role of the immune system during the establishment of labor is poorly understood. Understanding maternal immune adaptations during labor initiation can have important ramifications for predicting successful labor induction and labor complications in both induced and spontaneous types of labor. The aim of this study was to characterize labor-associated maternal immune system dynamics from labor induction to the start of active labor. Serial blood samples from fifteen participants were collected immediately prior to labor induction (baseline) and during the latent phase until the start of active labor. Using high-dimensional mass cytometry, a total of 1,059 single-cell immune features were extracted from each sample. A multivariate machine-learning method was employed to characterize the dynamic changes of the maternal immune system after labor induction until the establishment of active labor. A cross-validated linear sparse regression model (least absolute shrinkage and selection operator, LASSO) predicted the minutes since induction of labor with high accuracy (R = 0.86, p = 6.7e-15, RMSE = 277 min). Immune features most informative for the model included STAT5 signaling in central memory CD8+ T cells and pro-inflammatory STAT3 signaling responses across multiple adaptive and innate immune cell subsets. Our study reports a peripheral immune signature of labor induction, and provides important insights into biological mechanisms that may ultimately predict labor induction success as well as complications, thereby facilitating clinical decision-making to improve maternal and fetal well-being.
| S-EPMC8458888 | biostudies-literature
Project description:BackgroundTo analyze blood loss after delivery in women with induction of labor compared to women with spontaneous onset of labor.MethodsIn this secondary analysis of a prospective cohort study investigating postpartum hemorrhage, 965 deliveries were analyzed including 380 women with induction of labor (39%) between 2015 and 2016. Primary outcome parameters were rate of postpartum hemorrhage, estimated blood loss and post-partum decrease in hemoglobin.ResultsRates of postpartum hemorrhage and estimated blood loss were not significantly different in women with induction of labor. Women with induction of labor had a significantly reduced decrease in hemoglobin after delivery. In the multivariate linear regression analysis, induction of labor remained associated with reduced decrease in hemoglobin. Secondary maternal and neonatal outcomes were unaffected.ConclusionsInduction of labor is not associated with increased blood loss after delivery and should not be regarded as a risk factor for postpartum hemorrhage.
| S-EPMC6659310 | biostudies-literature