Tachysystole and risk of cesarean section after labor induction using misoprostol: A cohort study

Sichitiu, Joanna; Vial, Yvan; Panchaud, Alice; Baud, David; Desseauve, David

doi:10.1016/j.ejogrb.2020.04.026

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…In our present study only IUP revealed the association between OD due to fetal distress and increasing UA, whereas contraction frequency or baseline tone did not show a statistically significant association. This is in line with earlier studies with respect to frequency, 21–24 although only Bofill et al 22 . mentioned the indication for CS.…”

Section: Discussionsupporting

confidence: 91%

“…Bakker et al 21 In our present study only IUP revealed the association between OD due to fetal distress and increasing UA, whereas contraction frequency or baseline tone did not show a statistically significant association. This is in line with earlier studies with respect to frequency, [21][22][23][24] although only Bofill et al 22 mentioned the indication for CS. As the incidence of UmA pH ≤7.10 was low when CS was performed due to fetal distress in this present study, it seems the timing of CS was correct.…”

Section: Operative Delivery Due To Fetal Distress N = 74supporting

confidence: 89%

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Uterine contractile activity and neonatal outcome – A blind analysis of a randomized controlled trial cohort

Juhantalo,

Hautakangas,

Palomäki

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionSufficient contractions are necessary for a successful delivery but each contraction temporarily constricts the oxygenated blood flow to the fetus. Individual fetal or placental characteristics determine how the fetus can withstand this temporary low oxygen saturation. However, only a few studies have examined the impact of uterine activity on neonatal outcome and even less attention has been paid to parturients’ individual characteristics. Our objective was therefore to find out whether fetuses compromised by maternal or intrapartum risk factors are more vulnerable to excessive uterine activity.Material and methodsUterine contractile activity was assessed by intrauterine pressure catheters. Women (n = 625) with term singleton pregnancies and fetus in cephalic presentation were included in this secondary, blind analysis of a randomized controlled trial cohort. Intrauterine pressure as Montevideo units (MVU), contraction frequency/10 min and uterine baseline tone were calculated for 4 h prior to birth or the decision to perform cesarean section. Uterine activity in relation to umbilical artery pH linearly or ≤7.10 was used as the primary outcome. Need for operative delivery (either cesarean section or vacuum‐assisted delivery) due to fetal distress was analyzed as a secondary outcome. In addition, belonging to vulnerable subgroups with, for example, chorioamnionitis, hypertensive or diabetic disorders, maternal smoking or neonatal birthweight <10th percentile were investigated as additional risk factors.ResultsA linear decline in umbilical artery pH was seen with increasing intrauterine pressure in all deliveries (p < 0.001). Among parturients with suspected chorioamnionitis, every increasing 10 MVUs increased the likelihood of umbilical artery pH ≤7.10 (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.02–1.34, p = 0.023). The need for operative delivery due to fetal distress was increased among all laboring women by every increasing 10 MVUs (OR 1.05, 95% CI 1.01–1.09, p = 0.015). This association with operative deliveries was further increased among parturients with hypertensive disorders (OR 1.23, 95% CI 1.05–1.43, p = 0.009) and among those with diabetic disorders (OR 1.13, 95% CI 1.04–1.28, p = 0.003).ConclusionsIncreasing intrauterine pressure impairs umbilical artery pH especially among parturients with suspected chorioamnionitis. Fetuses in pregnancies affected by chorioamnionitis, hypertensive or diabetic disorders are more vulnerable to high intrauterine pressure.

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Section: Discussionsupporting

confidence: 91%

Section: Operative Delivery Due To Fetal Distress N = 74supporting

confidence: 89%

Uterine contractile activity and neonatal outcome – A blind analysis of a randomized controlled trial cohort

Juhantalo,

Hautakangas,

Palomäki

et al. 2024

Acta Obstet Gynecol Scand

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“…Vaginal misoprostol was the most effective option for cervical preparation compared with oxytocin, dinoprostone (prostaglandin E2), and placebo, without increasing cesarean section rates or tachysystole with changes in fetal heart rate 2 . Despite a higher incidence of tachysystole when induction was performed with misoprostol, this did not imply differences in cesarean section rates or neonatal outcomes 11 . In a meta-analysis published by Wang et al 12 , including 8 studies with 1,669 pregnant women, the use of vaginal misoprostol showed less oxytocin augmentation when compared with dinoprostone.…”

Section: Discussionmentioning

confidence: 93%

Evaluation of the efficacy of labor induction with vaginal misoprostol in a low-risk pregnant women population

Vilas-Boas,

Sanches,

Araujo Júnior

et al. 2024

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the success rate and predictors of labor induction using vaginal misoprostol in a low-risk pregnant women population. METHODS: A prospective cohort study was carried out with 196 pregnant women. Groups 2 and 4 of the Robson Classification admitted for induction of labor with vaginal misoprostol (25 μg tablets every 6 h, up to 4 tablets, for a maximum of 24 h). The success of labor induction was considered the achievement of vaginal delivery. Binary logistic regression was used to determine the best predictors of successful induction of labor with vaginal misoprostol. RESULTS: Of all the pregnant women analyzed, 140 (71.4%) were successful and 56 (28.6%) were unsuccessful. Pregnant women who achieved successful induction had a higher number of pregnancies (1.69 vs. 1.36, p=0.023), a higher number of deliveries (0.57 vs. 0.19, p<0.001), a higher Bishop score (2.0 vs. 1.38, p=0.002), and lower misoprostol 25 μg tablets (2.18 vs. 2.57, p=0.031). No previous deliveries [x 2 (1)=3.14, odds ratio (OR): 0.24, 95% confidence interval (CI): 0.10–0.57, R 2 Nagelkerke: 0.91, p=0.001] and the presence of one previous delivery [x 2 (1)=6.0, OR: 3.40, 95% CI: 1.13–10.16, R 2 Nagelkerke: 0.043, p=0.029] were significant predictors of successful induction of labor with vaginal misoprostol. CONCLUSION: A high rate of labor induction success using vaginal misoprostol in a low-risk population was observed, mainly in multiparous and with gestational age>41 weeks. No previous delivery decreased the success of labor induction, while one previous delivery increased the success of labor induction.

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“…On the other hand, in the period up to 48 h, despite the slight dominance of nonreassuring fetal heart rate patterns, the percentage of lack of progression in labor as an indication for cesarean section increases (40.2%, 44.2%, and 61.4%). We believe that the higher rate of cardiotocographic changes diagnosed as threatening fetal asphyxia within 24 h may also be due to tachysystole [ 27 , 28 ]. Uterine hyperstimulation can often be confused with an abnormal CTG record (nonreassuring fetal heart rate patterns), which was the main indication for cesarean section.…”

Section: Discussionmentioning

confidence: 99%

Risk of Cesarean Delivery after Vaginal Inserts with Prostaglandin Analogs and Single-Balloon Catheter Used for Cervical Ripening and Induction of Labor

et al. 2023

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(1) Background: Induction of labor is currently the most frequently performed procedure in modern obstetrics, referring to more than one in five women, and it is postulated that the percentage of labor induction will increase. (2) Methods: In total, 2935 patients in uncomplicated full-term pregnancy fulfilled the study inclusion criteria and underwent induction of labor. Pregnant women were divided into three groups: IOL with Dinoprostone, Misoprostol vaginal suppositories, and Foley catheter. Outcomes, including cesarean section rates, time to delivery, and cesarean section indications, were analyzed. (3) Results: There was statistically significantly more cesarean sections within 24 h in the Misoprostol group in comparison with the Dinoprostone and Foley catheter groups (p < 0.0001). The percentage of patients who had a cesarean section due to clinically diagnosed threatened fetal asphyxia was 63% in the Dinoprostone group, 81.3% in the Misoprostol group, and 55.3% in the Foley catheter group. There were statistically significantly more cesarean deliveries due to nonreassuring fetal heart rate patterns within 24 h in the Misoprostol group in comparison with the Dinoprostone and Foley catheter groups (p = 0.0031 and p = 0.0363). (4) Conclusions: Misoprostol may cause a more turbulent and violent course of labor, with a higher rate of increased incidence of nonreassuring fetal heart rate patterns and cesarean deliveries. The use of a Dinoprostone vaginal insert or Foley catheter may provide longer labor, although still within 48 h, with a lower risk of cesarean section caused by nonreassuring fetal heart rate patterns.

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Tachysystole and risk of cesarean section after labor induction using misoprostol: A cohort study

Cited by 3 publications

References 24 publications

Uterine contractile activity and neonatal outcome – A blind analysis of a randomized controlled trial cohort

Uterine contractile activity and neonatal outcome – A blind analysis of a randomized controlled trial cohort

Evaluation of the efficacy of labor induction with vaginal misoprostol in a low-risk pregnant women population

Risk of Cesarean Delivery after Vaginal Inserts with Prostaglandin Analogs and Single-Balloon Catheter Used for Cervical Ripening and Induction of Labor

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