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PubMed1983

A prospective randomized study of induction of labor.

In a prospective randomized study spontaneous and oxytocin induced labor have been compared with respect to duration of labor and the condition of the fetus and the newborn infant. The study consists of 166 normal patients at full term. No significant differences between the two groups were found, and the results of the study showed that induction of labor between the 40th and 41st week of pregnancy was safe for the fetus. It is concluded that there seems to be no increased risks to mother or fetus from induction of labor compared to normal labor provided that there is cephalic presentation and a normal pregnancy.

Female↗

PubMed1982

Intracervical application of prostaglandin gel for induction of term labor.

A new gel for local application of prostaglandins has been elaborated. The new gel, based on a lyophilized prostaglandin E2 (PGE2) starch powder, seems to have solved most of the pharmaceutical and clinical problems associated with local administration of prostaglandins. In a randomized double-blind study, 50 nulliparous patients with an unfavorable cervical state at term were given 2 ml gel containing 0.5 mg PGE2 (PGE2 gel) or gel without PGE2 (placebo gel). The gel was deposited into the cervical canal. Among patients given PGE2 gel, 11 of 25 had induced labor, delivering without further stimulation within 24 hours. In patients given placebo gel, 2 of 25 were delivered with 24 hours. This difference is statistically significant (P less than .01). Patients undelivered after treatment with PGE2 gel achieved a considerable and statistically significant improvement of cervical score, whereas in patients in whom labor was not induced successfully by placebo gel treatment no significant changes in cervical score were registered. In a subsequent open study another 70 term patients of varied parity were given 0.5 mg PGE2 gel. Thirty-eight patients (54%) had successfully induced labor. Among the remaining undelivered patients, considerable ripening of the cervix occurred. Thus, the cervical score changed from a mean of 3.2 prior to treatment to a mean of 6.5 by 24 hours after treatment. Gastrointestinal discomforts were not observed. Signs of uterine hyperstimulation were registered in 1 patient.

Adolescent↗

PubMed1983

Insulin and glucose requirements during the first stage of labor in insulin-dependent diabetic women.

Studies utilizing glucose-controlled insulin infusion systems were undertaken to more accurately define the glucose and insulin requirements during the first stage of labor induced by oxytocin in 12 insulin-dependent diabetic women in whom normoglycemia had been maintained before delivery. Insulin requirements decreased to zero during active stage 1 labor, while the glucose infusion rate necessary to maintain a blood glucose level of 70 to 90 mg/dl (or 3.9 to 5.0 mmol/liter) was constant at 2.55 mg/kg per minute. The findings were confirmed in 40 additional studies of oxytocin-induced labor. Studies of six women undergoing spontaneous labor and one nonpregnant woman receiving oxytocin confirmed that the decrement in the insulin requirement during stage 1 labor was not influenced by oxytocin infusion. The changes occurred regardless of whether epidural anesthesia was employed. Insulin requirements returned during the second stage of labor. Active stage 1 labor in diabetic women thus appears to be associated with a predictable decrease in the need for insulin and a constant glucose requirement.

Blood Glucose↗

PubMed2002

Outcome after elective labor induction in nulliparous women: a matched cohort study.

OBJECTIVE: To determine whether elective induction of labor in nulliparous women is associated with changes in fetomaternal outcome when compared with labor of spontaneous onset. STUDY DESIGN: All 80 labor wards in Flanders (Northern Belgium) comprised a matched cohort study. From 1996 through 1997, 7683 women with elective induced labor and 7683 women with spontaneous labor were selected according to the following criteria: nulliparity, singleton pregnancy, cephalic presentation, gestational age at the time of delivery of 266 to 287 days, and birth weight between 3000 and 4000 g. Each woman with induced labor and the corresponding woman with spontaneous labor came from the same labor ward, and they had babies of the same sex. Both groups were compared with respect to the incidence of cesarean delivery or instrument delivery and the incidence of transfer to the neonatal ward. RESULTS: Cesarean delivery (9.9% vs 6.5%), instrumental delivery (31.6% vs 29.1%), epidural analgesia (80% vs 58%), and transfer of the baby to the neonatal ward (10.7% vs 9.4%) were significantly more common (P <.01) when labor was induced electively. The difference in cesarean delivery was due to significantly more first-stage dystocia in the induced group. The difference in neonatal admission could be attributed to a higher admission rate for maternal convenience when the women had a cesarean delivery. CONCLUSION: When compared with labor of spontaneous onset, elective labor induction in nulliparous women is associated with significantly more operative deliveries. Nulliparous women should be informed about this before they submit to elective induction.

Adult↗

PubMed2000

Induction of labor.

The goal of induction of labor is to achieve vaginal delivery by stimulating uterine contractions before the spontaneous onset of labor. According to the National Center for Health Statistics, the overall rate of induction of labor in the United States has increased from 90 per 1,000 live births in 1989 to 184 per 1,000 live births in 1997 (I). Generally, induction of labor has merit as a therapeutic option when the benefits of expeditious delivery outweigh the risks of continuing the pregnancy. The benefits of labor induction must be weighed against the potential maternal or fetal risks associated with this procedure. The purpose of this bulletin is to review current methods for cervical ripening and induction of labor and to summarize the effectiveness of these approaches based on appropriately conducted outcomes-based research. These practice guidelines classify the indications for and contraindications to induction of labor, describe the various agents used for cervical ripening, cite methods used to induce labor, and outline the requirements for the safe clinical use of the various methods of inducing labor.

Female↗

PubMed1983

Intracervical instillation of PGE2-gel in patients with missed abortion or intrauterine fetal death.

A single intracervical instillation of prostaglandin E2 (1.0 mg or 0.5 mg in viscous gel) was given to dilate the cervix before dilatation and evacuation in patients with missed abortion or intrauterine fetal death in late pregnancy. The 1.0-mg dose of PGE2 gave more prominent cervical dilatation in early pregnancy. In late pregnancy 1.0 mg PGE2 induced labor in the majority of patients and with shorter induction delivery time than in patients given 0.5 mg PGE2. There was no uterine hypertonus and no patients complained of gastrointestinal symptoms. We conclude that intracervical instillation of 1.0 mg of PGE2 in viscous gel is a safe and effective method both for dilating the cervix before dilatation and evacuation and as a method of inducing labor in patients with intrauterine fetal death.

Abortion, Missed↗

PubMed2001

Sequential use of Prepidil and extra-amniotic saline infusion for the induction of labor in nulliparous women with very low Bishop scores.

OBJECTIVE: To evaluate the efficacy of sequential use of Prepidil (prostaglandin E2 gel) and extra-amniotic saline infusion for the induction of labor in nulliparous women with very low Bishop scores. STUDY DESIGN: Nulliparous women with singleton gestations, intact membranes and a cervical Bishop score of < or = 2 who received Prepidil gel and extra-amniotic saline infusion sequentially for the induction of labor between July 1996 and July 1998 were studied. RESULTS: Thirty-one women met the inclusion criteria. Indications for induction included post-dates (six of 31), pre-eclampsia (ten of 31), diabetes (three of 31), oligohydramnios (three of 31), intrauterine growth restriction (two of 31) and non-reactive non-stress test (NST) (seven of 31). The average time from onset of induction to delivery was 38.1 +/- 13.5 h. Vaginal delivery was achieved in 80.6%. Women requiring > 2 doses of Prepidil had a higher risk of delivering abdominally (OR = 3.5). Three of seven (42.9%) women with labor induced for non-reactive NST but only three of 24 (12.5%) with labor induced for other indications had a Cesarean section delivery (p < 0.001). CONCLUSIONS: Nulliparous women with very unfavorable cervices can be counselled that they have an 80% chance of vaginal delivery using sequential Prepidil and extra-amniotic saline infusion as an induction method, with 90% delivering within the first 48 h.

Administration, Intravaginal↗

PubMed1999

Induction of labor with mifepristone--a randomized, double-blind study versus placebo.

OBJECTIVE: To evaluate the efficacy of mifepristone in inducing labor in women with an unripe cervix, its effect on the cervix and on the status of the newborn. METHODS: In a prospective double-blind study, 36 post-term pregnant women with a Bishop score of 5 or less received either 400 mg mifepristone (n=24) or placebo (n=12). If, 48 hours after the treatment was started, labor had not begun or the Bishop score was 5 or less, the women were given 0.5 mg prostaglandin E2 intracervically, a treatment which was repeated 12 hours later, if necessary. RESULTS: During the first 48 hours following treatment, 19 (79.2%) of the women treated with mifepristone and two of the women (16.7%) treated with placebo went into labor. In addition, one and three women, respectively, had a ripe cervix at the end of the 48h period. The overall success rate was thus 83.3% for mifepristone and 41.7% for placebo (p=0.008; OR 14.8; 95% CI 2.1-107.6). The median time from the start of treatment to delivery was also shorter (mifepristone 36h23' and placebo 53h17'). Treatment with intracervical PGE2 was needed more often after the placebo. The duration of labor, however, tended to be shorter after placebo than after mifepristone in the women who delivered vaginally. The frequencies of instrumental delivery were similar in both treatment groups. The median Apgar score was slightly lower at 1 minute (p<0.05) following mifepristone treatment, but did not differ at 5 and 10 minutes. There was no difference between the two treatment groups in the umbilical pH at delivery. CONCLUSION: The results of the present study show that mifepristone is a simple and effective treatment for inducing labor in post-term women with an unripe cervix.

Adult↗

PubMed1999

Modulation of the prostaglandin E receptor: a possible mechanism for infection-induced preterm labor.

OBJECTIVE: To evaluate the modulatory effects of interleukin (IL)-1beta and prostaglandin (PG)E2 on the PGE2 receptor subtype EP1 in amnion cell cultures. METHODS: Amnion cell cultures were incubated in increasing concentrations of (IL)-1beta or PGE2. Cultures were also incubated in high concentrations of IL-1beta and PGE2 in combination. Changes in EP1 receptor levels were evaluated by western and northern blot analysis. Culture fluid PGE2 levels were measured by enzyme-linked immunosorbent assay. RESULTS: EP1 receptor protein levels decreased with increasing levels of PGE2 (r = -0.82, P < .05). EP1 receptor protein (r = 0.95, P < .05), EP1 mRNA (r = 0.95, P < .01), and culture fluid PGE2 levels (P < .01) were all increased after IL-1beta administration. EP1 receptor levels also increased approximately fourfold in response to IL-1beta incubation even in the presence of high agonist (PGE2) concentrations (P < .01). CONCLUSION: The results of this study show that IL-1beta might be involved in infection-induced preterm labor by interfering with the normal regulation of EP1 receptor levels and with the promotion of increased PGE2 production in amnion tissue.

Cells, Cultured↗

PubMed2002

Induction of labor for vaginal birth after cesarean delivery.

A recent population-based study of vaginal birth after cesarean delivery (VBAC) attempts observed uterine rupture rates of 24.5 per 1,000 with prostaglandin-induced labor, while the uterine rupture rates with spontaneous labor and labor induced without prostaglandins were lower (5.2/1,000 and 7. 7/1,000 respectively). The authors did not confirm the diagnoses by examining individual medical records, so the actual incidence of uterine rupture may have been overstated. Despite this limitation, the Committee on Obstetric Practice concludes that the risk of uterine rupture during VBAC attempts is substantially increased with the use of various prostaglandin cervical ripening agents for the induction of labor, and their use for this purpose is discouraged.

Cesarean Section↗

PubMed1977

Effect of elective induction of labor with prostaglandins F2alpha and E2 and oxytocin on uterine contraction and relaxation.

Prostaglandins F2alpha and E2 and oxytocin were used to induce labor in 101 patients at risks. The data show that the three drugs are efficient labor inducers. The success rate of induction is the highest in primiparous patients receiving oral prostaglandin E2. Uterine contractility patterns and base line are similar with all drugs. The relaxation phase of the uterine contraction is skewed consistently in each investigated labor. This suggests an unequal relaxation time for the uterine fibers. It is concluded that prostaglandins E2 and F2alpha and oxytocin are safe drugs for induction of labor if monitoring is used in order to avoid an overdose of the medication. The three drugs must be synergistic because of their identical action on the uterine muscle.

Adult↗

PubMed1999

[Effects of castor oil-diet on the synthesis of prostaglandin E2 in pregnant rats].

OBJECTIVE: To determine effects of castor oil-diet on the synthesis of prostaglandin E2(PGE2) and explore the mechanism of labor induced by castor oil-diet in pregnant rats. METHODS: Pregnant rats were gavaged castor oil-diet in 18 and 19 days of gestation. At the time of death, blood of portal and peripheral veins, intestinal mucosa, amnion, amniotic cells and placenta were collected, and the tissues were cultured in the presence of ricinoleic acid or indomethacin. The concentrations of PGE2 in the media or blood were measured by RIA methods. RESULTS: The PGE2 levels in the portal vein increased, while the PGE2 levels in peripheral blood had no changes significantly, the PGE2 levels in the tissues of the intestinal mucosa, placenta, amnion and amniotic cells were increased significantly; Ricinoleic acid stimulated the synthesis of PGE2 in the above tissues in vitro, which had the positive correlations with the dose of ricinoleic acid and its lasting time. Indomethacin inhibited the synthesis of PGE2 in-vitro. CONCLUSION: The increased synthesis of PGE2 in the intrauterine tissues is a key of the initiation of labor induced by castor oil-diet, and ricinoleic acid in castor oil-diet might be the active component which induced the initiator of labor.

Animals↗

PubMed1992

Elective induction versus spontaneous labor: a retrospective study of complications and outcome.

OBJECTIVE: This retrospective study was undertaken to identify whether electively induced labor places the mother or her fetus at increased risk as compared with her spontaneous labor cohort. STUDY DESIGN: This study compares the labor, delivery, and fetal outcome of 253 parturients in which labor was electively induced with 253 matched controls who began labor spontaneously. All patients were delivered at Huntington Memorial Hospital in Pasadena, California, during the calendar year 1990. The patients were between 37 and 41 weeks' gestation and had no medical or obstetric conditions necessitating induction. The cases and controls were matched for age group, parity, gestational age, and delivering obstetrician. RESULTS: Epidural anesthesia was used in 83.8% of patients in the induction group versus 55.7% in the spontaneous group. Patients with labor induced had a shorter first stage of labor. Meconium staining was found significantly more often in the spontaneous group than in the induced group (16.2% vs 6.7%). This contributed to a greater rate of neonatal consultations in the spontaneous labor group. Although cesarean section rates between the two groups were similar, nulliparous patients in the induction group with an estimated Bishop score of less than or equal to 5 had a 50% cesarean section rate. Iatrogenic prematurity was not encountered. No differences existed between the two groups with respect to intrapartum maternal complications, fetal complications, or postpartum complications. CONCLUSIONS: When compared with spontaneous labor, elective induction of labor at term does not appear to pose an increased risk to the mother or her fetus in a carefully selected patient population. However, elective induction of labor in a nulliparous patient with an unfavorable cervix should be discouraged.

Cohort Studies↗

PubMed1997

A randomized comparison between misoprostol and dinoprostone for cervical ripening and labor induction in patients with unfavorable cervices.

OBJECTIVE: To compare the efficacy and safety of two prostaglandin derivatives, misoprostol and dinoprostone, for ripening the cervix and inducing labor in women with an unfavorable cervix. METHODS: One hundred fifty-five women admitted for induction of labor to St. John's Mercy Medical Center, a teaching community hospital, were randomized to one of two methods: intravaginal misoprostol, 50 microg every 4 hours up to three doses (n = 76); and intracervical dinoprostone gel, 0.5 mg every 6 hours up to three doses (n = 79). RESULTS: Misoprostol was more effective than dinoprostone in causing cervical ripening (P = .01), inducing labor (P < .001), shortening the duration of labor (P < .001), and decreasing the need for oxytocin augmentation (P < .001). Nonreassuring fetal heart monitoring patterns associated with hyperstimulation were significantly more frequent (P < .001), and the incidence of cesarean deliveries because of this indication was significantly higher (P = .002) in patients receiving misoprostol. CONCLUSIONS: Misoprostol is an effective agent for cervical ripening and labor induction, but it causes an increase in cesarean deliveries associated with uterine hyperstimulation.

Adult↗

PubMed1976

Cortisol levels in maternal venous and umbilical cord arterial and venous serum at vaginal delivery.

To provide evidence that the high levels of cortisol found in mixed cord serum at spontaneous delivery are derived from the fetus rather than the mother, arterial and venous cord samples were collected separately along with simultaneous maternal venous samples at term. In the group with spontaneous labor, the difference between umbilical arterial levels of cortisol (78.6 +/- 4.1 ng. per milliliter) exceeded venous levels (61.9 +/- 4.1 ng. per milliliter) (P less than 0.0001). In the group with induced labor, the arterial level (58.4 +/- 6.9 ng. per milliliter) did not differ significantly from the venous level (50.6 +/- 5.9 ng. per milliliter) (P greater than 0.05). In four cases where spontaneous rupture of the membranes occurred prior to induction, values were similar to those of the group with spontaneous labor. The arterial levels of the group with spontaneous labor exceeded those of the group with induced labor (P less than 0.02). These differences cannot be related to duration of labor, gestational age, or maternal cortisol concentration, none of which differed between the group with electively induced and spontaneous labor. The present data provide further evidence that a rise in fetal cortisol production independent of the mother precedes and is involved in the mechanism initiating the spontaneous onset of human labor.

Delivery, Obstetric↗

PubMed1976

Oral prostaglandin E2 for labor induction in high-risk pregnancy.

Oral prostaglandin E2 (PGE2) was used alone or synergistically with intravenous oxytocin to induce labor in 84 women whose pregnancies were at high risk. A control group of 84 similar high-risk pregnancies where labor was induced with intravenous oxytocin alone was studied to compare the safety and efficacy of the two regimens. Oral PGE2 administration, combined with the synergistic effect of intravenous oxytocin, is safe for induction of labor in gravid women whose fetuses are at risk. Uterine polysystole, which is potentially dangerous, especially to the high-risk fetus, was not commonly encountered and only once was associated with transient fetal bradycardia. Uterine hypertonus was not encountered with PGE2; however, it did occur with oxytocin stimulation. Nausea and vomiting occurred in one third of the women treated with PGE2 but were well tolerated and required discontinuation of the drug in only one instance. There was no apparent advantage of using the combination PGE2 regimen in patients whose cervices were more favorable for induction of labor (Bishop score, 5 to 9). However, oral PGE2, used either alone or synergistically with oxytocin, appears twice as effective in inducing labor than was oxytocin alone in women in whom labor was considered to be "difficult to induce" (Bishop score, 0 to 4).

Administration, Oral↗

PubMed1999

Delivery after previous cesarean: a risk evaluation. Swiss Working Group of Obstetric and Gynecologic Institutions.

OBJECTIVE: To examine the risks of vaginal delivery after previous cesarean and to find criteria to help decide whether a trial of labor or an elective repeat cesarean should be preferred. METHODS: We evaluated 29,046 deliveries after previous cesarean registered in a pooled database of 457,825 deliveries used to assess quality control in gynecology and obstetrics departments in Switzerland. RESULTS: Among the 17,613 trial-of-labor cases logged (attempt rate 60.64%), the success rate was 73.73% (65.56% after inducing labor and 75.06% after the spontaneous onset of labor). The following complications were significantly more frequent in the previous-cesarean group: maternal febrile episodes (relative risk [RR] 2.77; 95% confidence interval [CI] 2.52, 3.05), thromboembolic events (RR 2.81; CI 2.23, 3.55), bleeding due to placenta previa during pregnancy (RR 2.06; CI 1.70, 2.49), uterine rupture (92 cases; RR 42.18; CI 31.09, 57.24), and perinatal mortality (118 cases, including six associated with uterine rupture; RR 1.33; CI 1.10, 1.62). The postcesarean group also showed a 0.28% rate of peripartum hysterectomy (81 cases; RR 6.07; CI 4.71, 7.83). There was one maternal death in the group, compared with 14 maternal deaths in the group without previous cesarean (no statistical significance). The risk of uterine rupture for patients with previous cesareans was elevated in the trial-of-labor group compared with the group without trial of labor (RR 2.07; CI 1.29, 3.30), but all other maternal risks, including peripartum hysterectomy (RR 0.36; CI 0.23, 0.56), were lower. When comparing the women having a trial of labor, the 70 with uterine rupture more often had induced labor (24.29% compared with 13.92% in the nonrupture group; P = .013), had epidural anesthesia (24.29% compared with 8.44%; P < .001), had an abnormal fetal heart rate tracing (32.86% compared with 8.53%; P < .001), and had failure to progress (21.43% compared with 7.98%; P = .001). CONCLUSION: A history of cesarean delivery significantly elevates the risks for mother and child in future deliveries. Nonetheless, a trial of labor after previous cesarean is safe. Induction of labor, epidural anesthesia, failure to progress, and abnormal fetal heart rate pattern are all associated with failure of a trial of labor and uterine rupture.

Adult↗

PubMed1977

[Programmed labor: methods, results, guidelines (author's transl)].

The programming of labor (setting the best possbile time under optimal conditions) was carried out in the University Women's Hospital, Freiburg i. Br. between 1970 and 1975 in 1121 cases. No perinatal mortality was reported. The secondary frequency of cesarean section for this primarily uncomplicated labor was 3.21% (general hospital statistics for this time period: 6.29%). The most important factors for the strict standardized method of induction is the observation of the pelvic score (desired: greater than 6) and a moderate dose of oxytocin or prostaglandin based on the essential amniotomy. In a statistical comparison of three groups of patients (n = 786): programmed labor (n = 427), induction via the same type of method where transference was suspected (n = 158), and uncomplicated spontaneous labor (n=183), the results with induced labor were better than those with spontaneous labor. In addition for the fact that the course of labor could be preplanned and the period of labor shortened intrauterine and partal complications occurred less frequently with programmed labor than with spontaneous labor. Placental complications and the tendency toward postpartum atony must be discussed. Minor complications decreased as the weight, length and gestation period of the newborn increased. Individual palpation until the physiological maturity for birth is reached would, therefore, seem to be required. Observe the conditions and increase antepartal controls. Only by setting the exact time for labor with modern methods of supervision is it theoretically possible to eliminate the danger of active management. The organizational problem involved with a general programming of labor poses the major problem at present.

Cesarean Section↗