Outcomes of Elective Induction of Labor Compared With Expectant Management

Abstract

rates of fetal macrosomia or maternal obesity. Women undergoing TOLAC without a prior vaginal delivery compared to women undergoing TOLAC with a prior vaginal delivery were older (median age, 24 vs. 19 y, P < 0.001), were of higher gravidity (2 vs. 1, P < 0.001), and more likely had body mass index of >30 kg/m 2 (relative risk, 1.39; 95 confidence interval, 1.03-1.89). These 2 groups did not differ significantly in rates of cervical dilation; median times for dilation from 4 to 10 cm were 3.0 hours for TOLAC and 2.8 hours for non-TOLAC patients. In women without a previous vaginal delivery, the median time of the active phase of labor did not differ based on the presence of a uterine scar and was 3.7 hours in both groups. Labor curves, when stratified by TOLAC status, overlapped and revealed a gradual transition from the latent to active phase. No deceleration phase was noted.On the basis of these results, women undergoing TOLAC should be managed by the same standards as women without a uterine scar, which does not seem to affect the pattern of the first stage of spontaneous labor. Topics: Obstetric ComplicationsI nduction of labor is frequently used for postdate pregnancies (>41 wk gestation) to decrease perinatal mortality. However, no trial or meta-analysis with sufficient sample size has yet examined the effects of labor induction on perinatal mortality between 37 and 41 weeks' gestation. This retrospective cohort study was undertaken to determine neonatal and maternal outcomes after elective induction of labor compared with expectant management.Data were obtained from several Scottish databases, including the General Register Office for Scotland database, which links maternity, neonatal, and stillbirth/infant death records. Deliveries between January 1981 and December 2007 were examined. Women were considered as having elective inductions if they had no medical indications for induction of labor. These women, induced at 37, 38, 39, 40, and 41 weeks' gestation, were compared with women who had expectant management with continuation of pregnancy to either spontaneous labor, induction of labor, or cesarean section at a later gestation. Outcomes examined included extended perinatal mortality, admission of neonate to the neonatal intensive care unit, mode of delivery, postpartum hemorrhage, obstetric anal sphincter injury, shoulder dystocia, and uterine rupture. Extended perinatal mortality was defined as stillbirth and death in the first month of life, excluding deaths related to congenital anomalies. These outcomes were adjusted for age at delivery, parity, year of birth, birth weight, deprivation category (defined by post code), and mode of delivery.From 1,605,601 deliveries during the study period, 176,136 women had elective induction of labor and 938,364 did not have induction. Women undergoing induction of labor were older, more likely to be primiparous, and less likely to be in the 2 highest level categories of deprivation. Labor inductions decreased from 1981 to 1990 but then began rising and peaked in 20...

Comparative study of misoprostol sublingually and dinoprostone gel intracervically for cervical ripening and induction of labor

“…Timely induction thus reduces the maternal and perinatal morbidity and mortality. 1,2 Prostaglandin preparations are well known and widely accepted for inducing labor. Dinoprostone which is Prostaglandin E2 analog is approved drug by Food and drug administration (FDA), USA for the induction of labor, but it is expensive and required refrigeration for its storage.…”

Translating Guidelines and Public Policy Into Optimal Health Care for Women

“…1,2 These recommendations are based on sound evidence of increased short-term neonatal morbidity (neonatal intensive care unit admission rates of 13-21%), 3 more cesarean deliveries, and longer maternal length of stay in neonates delivered at earlier than 39 weeks with no medical indication. [4][5][6] Despite the strong recommendation against these non-medically indicated elective deliveries, some colleagues continued to perform them. Although practice changes at the provider and hospital levels have resulted in some success, the proportion of live births occurring after 37 weeks but before 39 weeks increased from 19.7% in 1990 to 28.9% in 2006.…”

Vaginal Delivery: A Day-Care Procedure with the use of Day-Care Delivery Protocol

“…5 Induction of labor beyond 37 weeks of pregnancy can reduce perinatal mortality (death before, during or shortly after birth) without increasing cesarean section rates, as found in a study published on the British Medical Journal on May 10th, 2012. 1 Elective induction does not appear to pose an increased risk to the mother or her fetus in a carefully selected patient population as published in the Journal of Obstetrics and Gynecology of India [Vol 61(6) Dec 2011]. 2 Cesarean sections are now an accepted part of delivery in situations where neonatal and maternal risk is anticipated, or vaginal delivery does not seem possible, with almost 26 to 30% lower, segment cesarean section (LSCS) rates as per the WHO report (on 12th Jan, 2010).…”

“…This is followed by activation of labor under close monitoring with assessment of outcomes and routine follow-up. 1,2 Patient selection begins during the first antenatal visit in a healthy. ANC inclusion depends on her willingness after DCD counseling.…”

“…2,7 We have largely succeeded, except probably obstetrics, which still remains the most unnoticed, unpredictable and neglected process. 1 In an effort to combat this problem, we started a closely monitored activation and augmentation of labor that we call-the day-care delivery (DCD) using a set DCD protocol, with subsequently favorable outcomes, without waiting for the complications to actually set in. 7,8 The Concept of DCD Day-care delivery can be defined as a planned activation and augmentation of labor at term gestation, managed with the intention of vaginal delivery before nightfall.…”