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PubMed1986

Induction of labor in postterm pregnant women.

We have studied the outcome of labor induction in 145 postterm pregnant women in whom gestational age was properly assessed by ultrasound scanning. The induction techniques were adapted to the cervical states of the patients. Seventy-five patients (32 nulliparous and 43 multiparous) with favorable cervical states were successfully induced with intravenous oxytocin. In this group the frequency of Caesarean section was 2%. Seventy patients (45 nulliparous and 25 multiparous) with unripe cervices received 0.5 mg PGE2 in viscous gel intracervically to prime the cervix and to induce labor; 38 (52%) were induced into labor after a single PGE2-gel application whereas 26 (48%) needed labor augmentation with intravenous oxytocin after PGE2-gel obtained cervical ripening. In 6 of the 20 patients the cervix did not ripen and the PGE2-gel application had then to be repeated. The frequency of cesarean sections was 11%. In 5 out of the 145 patients (4%) the fetuses had signs of intrauterine growth retardation (IUGR) as assessed by ultrasound scanning, and postmaturity as verified by pediatric examination at delivery. All these fetuses belonged to nulliparous women with unripe cervices and all had to be delivered instrumentally (3 by cesarean section and 2 by ventouse) indicating the fragility of these children. If postterm pregnancy is complicated by an unfavorable cervical state intracervical application of PGE2-gel seems to be an efficient method to prime the cervix and to induce labor. In most patients an uncomplicated vaginal delivery can be achieved by this procedure. However, nulliparous women with unfavorable cervices and signs of IUGR constitute a high risk group of patients at labor induction.

Adolescent↗

PubMed2004

Cervical ripening with transcervical foley catheter and the risk of uterine rupture.

OBJECTIVE: To estimate whether the rate of uterine rupture in patients with a previous cesarean delivery is related to labor induction and/or cervical ripening using transcervical Foley catheter. METHODS: Charts of all patients who had a trial of labor after a previous cesarean delivery in our institution between 1988 and 2002 were reviewed. The rates of successful vaginal birth after cesarean delivery and uterine rupture in patients with spontaneous labor (control group) were compared with those of patients who underwent a labor induction by means of amniotomy with or without oxytocin and patients who underwent a labor induction/cervical ripening using a transcervical Foley catheter. Logistic regression analysis was performed to adjust for confounding variables. RESULTS: Of 2479 patients, 1807 had a spontaneous labor, 417 had labor induced by amniotomy with or without oxytocin, and 255 had labor induced by using transcervical Foley catheter. The rate of successful vaginal birth after cesarean delivery was significantly different among the groups (78.0% versus 77.9% versus 55.7%, P <.001), but not the rate of uterine rupture (1.1% versus 1.2% versus 1.6%, P =.81). After adjusting for confounding variables, the odds ratio (OR) for successful vaginal birth after cesarean delivery was 0.68 (95% confidence interval [CI] 0.41, 1.15), and the OR for uterine rupture was 0.47 (95% CI 0.06, 3.59) in patients who underwent an induction of labor using a transcervical Foley catheter when compared with patients with spontaneous labor. CONCLUSION: Labor induction using a transcervical Foley catheter was not associated with an increased risk of uterine rupture.

Adult↗

PubMed2002

Committee opinion. 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 7.71/1,000 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.

Contraindications↗

PubMed1976

Induction of labor with prostaglandin E2 administered orally.

The effectiveness of orally administered prostaglandin E2 in inducing labor was studied in 60 patients with uncomplicated, full-term pregnancies, using three dosage schedules. Although 40 patients did deliver, 11 patients' amniotic membranes ruptured at a time considered by the investigators to introduce an undesired variable in attempting to evaluate the drug. Twenty (33%) failed to deliver despite adequate Bishop scores. Side effects were noted in 45% of patients. No significant advantage for induction of labor occurred with the three dosage schedules used.

Adult↗

PubMed2002

Severe preeclampsia and the very-low-birth-weight infant. The controversy over delivery mode continues.

OBJECTIVE: To compare the effects of labor induction with those of cesarean delivery without labor on neonatal outcome in pregnancies complicated by severe preeclampsia and delivery of very-low-birth-weight infants. STUDY DESIGN: This retrospective study covered 400 singleton, live-born infants who weighed 750-1,500 g at birth and were delivered because of severe preeclampsia. Outcome in infants delivered by cesarean section without labor was compared with that in infants exposed to labor induction. RESULTS: Of the 400 women with severe preeclampsia who delivered infants between 750 and 1,500 g; 280 (70%) had labor induced, and 120 (30%) delivered without labor. Vaginal delivery was accomplished by 182 (65%) women in the induced group. Apgar scores of < or = 3 at five minutes was more common in the labor-induced group (6% versus 3%, P = .04); however, other neonatal outcomes, including respiratory distress syndrome, ventricular hemorrhage, sepsis, seizures and neonatal death, were similar in the two groups. Data analysis of the induced group did not reveal an association between route of delivery and neonatal outcome. Outcome in both groups was satisfactory at six months. CONCLUSION: Induction of labor in women with severe preeclampsia is not harmful to very-low-birth-weight infants and appears to be a safe mode of delivery.

Adult↗

PubMed2000

Maternal and neonatal outcomes after induction of labor without an identified indication.

OBJECTIVE: This study was undertaken to examine associations between induction of labor and maternal and neonatal outcomes among women without an identified indication for induction. STUDY DESIGN: This was a population-based cohort study of 2886 women with induced labor and 9648 women with spontaneous labor who were delivered at 37 to 41 weeks' gestation, all without identified medical and obstetric indications for induction. RESULTS: Among nulliparous women 19% of women with induced labor versus 10% of those with spontaneous labor underwent cesarean delivery (adjusted relative risk, 1.77; 95% confidence interval, 1.50-2.08). No association was seen in multiparous women (relative risk, 1.07; 95% confidence interval, 0. 81-1.39). Among all women induction was associated with modest increases in instrumental delivery (19% vs 15%; relative risk, 1.20; 95% confidence interval, 1.09-1.32) and shoulder dystocia (3.0% vs 1. 7%; relative risk, 1.32; 95% confidence interval, 1.02-1.69). CONCLUSION: Among women who lacked an identified indication for induction of labor, induction was associated with increased likelihood of cesarean delivery for nulliparous but not multiparous women and with modest increases in the risk of instrumental delivery and shoulder dystocia for all women.

Adult↗

PubMed1997

[Cervical maturation by repeated applications of prostaglandin E2 gel. 186 cases].

OBJECTIVE: A prospective clinical trial of cervical ripening with intracervical prostaglandin E2 gel in repeated administrations was performed. STUDY DESIGN: One hundred eighty-six patients were enrolled in this prospective trial between 01/01/89 and 31/12/93. these patients with unripe cervix (Bishop score < 5) required induction of labor because of pregnancy disorders. Mean patient age was 28.2 years (range 15 to 43), mean gestational age was 39.2 week's gestation (range 33 to 43) and mean parity was 1.8 (range 1 to 10). Our exclusion criterias were as follow: twin pregnancies, breech presentation and premature rupture of membranes. A 0.5 mg prostaglandin E2 gel was administered into the cervix every four hours maximal of three doses before induction of labor with oxytocin. Maternal and neonatal results were reviewed. RESULTS: Patients required a single dose of gel in 19.9% of cases, two doses in 26.3% and three doses in 53.8%. Induced labor during cervical ripening occurred in 55.4% of patients. A cesarean section was necessary in 22% of cases. This rate was both significantly related to the initial Bishop score and to the Bishop score at the end of the procedure. Patient with induced labor during the cervical ripening had a significantly lower cesarean section rate compared to these who needed induction with oxytocin (10.7% versus 33.8%; p < 0.01). The uterine hyperstimulation rate was 1.6%. A 1 min Apgar score less than 7 occurred in 1.1% of neonates. COMMENTS: Our results do not demonstrate benefit of repeated administration comparison to a single administration described in literature. Maternal and neonatal morbidity is low in this study but cervical ripening should be used only when pregnancy disorders require prompt delivery within twenty-four hours.

Administration, Intravaginal↗

PubMed2006

Essential role for IL-10 in resistance to lipopolysaccharide-induced preterm labor in mice.

IL-10 is highly expressed in the uterus and placenta and is implicated in controlling inflammation-induced pathologies of pregnancy. To investigate the role of IL-10 in regulating preterm labor, the response of IL-10 null mutant mice to low-dose LPS in late gestation was evaluated. When IL-10 null mutant C57BL/6 (IL-10(-/-)) and control (IL-10(+/+)) mice were administered LPS on day 17 of pregnancy, the dose of LPS required to elicit 50% preterm fetal loss was 10-fold lower in IL-10(-/-) mice than in IL-10(+/+) mice. Surviving fetuses in IL-10(-/-) mice exhibited fetal growth restriction at lower doses of LPS than IL-10(+/+) mice. Marked elevation of LPS-induced immunoactive TNF-alpha and IL-6 was evident in the serum, uterus, and placenta of IL-10(-/-) mice, and TNF-alpha and IL-6 mRNA expression was elevated in the uterus and placenta, but not the fetus. Serum IL-1alpha, IFN-gamma, and IL-12p40 were increased and soluble TNFRII was diminished in the absence of IL-10, with these changes also reflected in the gestational tissues. Administration of rIL-10 to IL-10(-/-) mice attenuated proinflammatory cytokine synthesis and alleviated their increased susceptibility to preterm loss. Exogenous IL-10 also protected IL-10(+/+) mice from fetal loss. These data show that IL-10 modulates resistance to inflammatory stimuli by down-regulating proinflammatory cytokines in the uterus and placenta. Abundance of endogenous IL-10 in gestational tissues is therefore identified as a critical determinant of resistance to preterm labor, and IL-10 may provide a useful therapeutic agent in this common condition.

Animals↗

PubMed1989

[Tissue pO2 and fetal heart activity during induction of labor with oxytocin].

A total of 65 women in labor complicated with uterine inertia were investigated for tissue pO2 and cardiac performance of fetuses under the effect of oxytocin. The authors stated that the aggravation of fetal status in drug-induced labors resulted from poorer tissue oxygenation caused by the activation of uterine contractility. In this line, hypoxic changes of the fetus were more pronounced in pregnancies complicated by nephropathy or prolonged pregnancy. Accurate monitoring of the fetal status and the character of induced labor course was found to be mandatory. Before oxytocin induction the fetus should be protected with diazepam.

Adult↗

PubMed1979

Regulation of bovine labor with a long-acting carba-analog of oxytocin: a preliminary report.

The long-acting oxytocin (OT) analog 1-desamino-1-monocarba-E12-Tyr(OMe)]-OT(dCOMOT) was given IV to 13 pregnant cows near to term, but not in actual labor. The animals were para 1 to 5. Of these cows, four were treated with 20 mg of dexamethoasone 48 hours before the peptide was injected; the remaining nine animals were given no other medication. The animals usually were given a single injection of 5 mg of dCOMOT into the jugular veiw (5 to 7 micrograms/kg of body weight). In those instances where delivery was not complete within six hours, a second injection of peptide was given. In all instances, the first injection initiated labor as judged by the behavior of both uterus and cow. In most instances, there was also intermittent spurting of colostrum from the udder over a six-hour period after injection. In the four cows treated first with dexamethasone, the mean duration of induced labor was 4.35 hours after dCOMOT injection. In the nine non-treated cows, the mean duration of induced labor was 14.25 hours. The difference between the two values was significant. For both groups separately, and all data together, there was a linear inverse relation between the size of the external ostium uteri at injection and the duration of labor after peptide injection. All calves were healthy with no signs of hypoxia and the dose rates used did not result in any instance of uterine tetany or tachyphylaxis.

Animals↗

PubMed1977

Plasma cortisol concentration in newborn infants.

Plasma cortisol was measured in cord and neonatal blood. Cortisol concentration in neonates decreased rapidly during the first three days after delivery and thereafter remained at an almost constant level. The more the delivery was stressful, the higher the cortisol in the 1-day-old infant, but the concentration came down to the same level as in the less stressful delivery on the 3rd day of the infants' life. The cortisol level in vaginal delivery after spontaneous labor was not different from that in vaginal delivery after oxytocin induced labor. Cortisol in small-for-date infants or infants with hyperbilirubinemia was lower than in average-for-date infants or infants without hyperbilirubinemia.

Cesarean Section↗

PubMedDate not supplied

Serum nitrites predict the response to prostaglandin-induced delivery at term.

OBJECTIVE: To evaluate whether the clinical response to prostaglandin-induced labor is modulated by nitric oxide (NO) activity. METHODS: Fifty-two cases of nulliparous women at term who delivered vaginally after prostaglandin E (PGE) induction of labor were enrolled. The induction was required mainly for amniotic fluid reduction or late-onset gestational hypertension. Either intracervical (0.5 mg) or vaginal (2.0 mg) PGE was administered every 12 hours, according to the Bishop score. After the third PGE application, in absence of labor onset, intravenous oxytocin was used. Nitrites/nitrates (NOx) serum levels were used as a marker of NO activity. They were measured just before the start of induction by using an enzymatic reduction and then a colorimetric evaluation. Time to delivery from the first PGE application was the main outcome variable. RESULTS: Time to delivery ranged from 4 to 62 hours (median: 15.5). Nitrites/nitrates levels were unaffected by both gestational age, Bishop score at entry, indication allowing labor-induction, fetal position, and birth weight. In a multiple regression analysis including the previous factors, NOx levels significantly explained 33.9% of the variance of the time to delivery. Indeed, patients delivering within 15 hours (26.4 +/- 6.9) showed NOx levels significantly lower than in patients delivering after more than 15 hours (39.5 +/- 16.4) from the first PGE application. CONCLUSIONS: A reduced level of NOx is associated with a prompt clinical response to PGE-induced labor. Provided we do not know the origin of NOx in the general circulation, these data indicate NOx levels as predictors of the response to PGE-induced delivery at term and support the hypothesis that labor onset is modulated by the endogenous NO activity.

Adult↗

PubMed1981

A simpler approach to labor induction using lipid-based prostaglandin E2 vaginal suppository.

The outcome of labor induced by use of a glyceride-based vaginal suppository of prostaglandin E2 (PGE2) inserted 3 hours before amniotomy, when the cervix is favorable, has been assessed. Using 5 mg PGE2 for primigravidas and 2.5 mg for multigravidas, 63% of the former and 81% of the latter established labor and were delivered of their infants without oxytocin augmentation, allowing ambulation during early labor. No maternal complications were detected as a result of the PGE2 treatment. Compared with patients undergoing conventional induction by amniotomy and immediate oxytocin titration there was no difference in the duration of labor, with a few patients establishing labor and giving birth quickly with both induction methods. Fetal distress was less common following PGE2 treatment than following conventional induction, with three patients in each group requiring delivery by cesarean section. Cephalopelvis disproportion in the second stage of labor requiring cesarean section to deliver occurred more frequently in the prostaglandin-treated group, possibly as a result of reduced upper segment contractility in the first stage of labor with subsequent poor fetal head molding. Epidural analgesia and postpartum hemorrhge were both reduced following PGE2-induced labor.

Adult↗

PubMed1996

Induction of labor compared with expectant management for prelabor rupture of the membranes at term. TERMPROM Study Group.

BACKGROUND: As the interval between rupture of the fetal membranes at term and delivery increases, so may the risk of fetal and maternal infection. It is not known whether inducing labor will reduce this risk or whether one method of induction is better then another. METHODS: We studied 5041 women with prelabor rupture of the membranes at term. The women were randomly assigned to induction of labor with intravenous oxytocin; induction of labor with vaginal prostaglandin E2 gel; or expectant management for up to four days, with labor induced with either intravenous oxytocin or vaginal prostaglandin E2 gel if complications developed. The primary outcome was neonatal infection. Secondary outcomes were the need for cesarean section and women's evaluations of their treatment. RESULTS: The rates of neonatal infection and cesarean section were not significantly different among the study groups. The rates of neonatal infection were 2.0 percent for the induction-with-oxytocin group, 3.0 percent for the induction-with-prostaglandin group, 2.8 percent for the expectant-management (oxytocin) group, and 2.7 percent for the expectant-management (prostaglandin) group. The rates of cesarean section ranged from 9.6 to 10.9 percent. Clinical chorioamnionitis was less likely to develop in the women in the induction-with-oxytocin group than in those in the expectant-management (oxytocin) group (4.0 percent vs. 8.6 percent, P<0.001), as was postpartum fever (1.9 percent vs. 3.6 percent, P=0.008). Women in the induction groups were less likely to say they liked "nothing" about their treatment than those in the expectant-management groups. CONCLUSIONS: In women with prelabor rupture of the membranes at term, induction of labor with oxytocin or prostaglandin E2 and expectant management result in similar rates of neonatal infection and cesarean section. Induction of labor with intravenous oxytocin results in a lower risk of maternal infection than does expectant management. Women view induction of labor more positively than expectant management.

Adult↗

PubMedDate not supplied

[Induction of labor by misoprostol, an analog of PGE1. A prospective study of 200 cases].

We carried out a prospective study of 200 pregnant women who required induction of labor at full term, at the Lalla Meryem maternity unit of the Ibn Rochd University Hospital, Casablanca, between January 1st 1996 and June 30th 1997. The aim of this study was to evaluate the efficacy, tolerance and acceptance of misoprostol (Cytotec) as a drug for inducing labor in unfavorable conditions (Bishop < 5). Misoprostol (a PGE1 analog) was administered to the women via the vagina, with a dose of 1/4 tb (50 mg) given every 6 hours, and a maximum of 3 doses (150 mg). If labor had not begun 18 h after the start of the protocol, misoprostol induction was considered to have failed. We found that misoprostol failed to induce labor in 5% of cases, Syntocinon was required in 40% of cases and the interval between misoprostol insertion and vaginal delivery was 13.3 + 11.1 h. The rate of delivery by cesarean section was 22% and the mean amount of misoprostol required was 1.3 doses (66 mg). The mean cost of labor induction was 0.6 FF, the frequency of uterine hyperstimulation was 3.5% and maternal, fetal and neonatal tolerance was good. Our results confirm that intravaginal misoprostol is very effective and well tolerated for the induction of labor in pregnant women at full term, in unfavorable obstetric conditions.

Administration, Intravaginal↗

PubMed1983

Oxytocin and the initiation of human parturition. IV. Plasma concentrations of oxytocin and 13,14-dihydro-15-keto-prostaglandin F2 alpha during induction of labor by artificial rupture of the membranes.

The influence of artificial rupture of the membranes on plasma levels of 13,14-dihydro-15-keto-prostaglandin F2 alpha (PGFM) and oxytocin was examined in 23 pregnant women at term. Serial blood samples were collected before and 15 minutes, 2 hours, 5 hours, and 8 hours after artificial rupture of the membranes. A significant rise in the concentration of plasma PGFM was observed at 15 minutes in the majority of women (20 of 23), but the magnitude of this early rise or the lack thereof was not related to the subsequent course of labor. The concentration of plasma PGFM at 2 hours was, on the other hand, significantly correlated with the induction-delivery interval. Amniotomy, by itself, induced labor and delivery when the increased PGFM levels were maintained from 2 to 5 hours after the procedure (n = 16). In those cases where Pitocin stimulation was required for adequate uterine contractions, it was found that plasma PGFM levels had declined to initial values at 2 hours. Pitocin infusions then partially reversed this decline. In one patient, the cervix failed to dilate in spite of prolonged Pitocin infusion which did not induce significant uterine contractions, and the infusion did not reverse the marked fall in plasma PGFM after the early but transient rise. Mean plasma oxytocin levels did not rise significantly during labor induced by artificial rupture of the membranes and were, on the average, similar to the levels observed during the first stage of spontaneous or oxytocin-induced labor. Considering the previously demonstrated maximal levels of uterine oxytocin receptors in early labor, the absence of a rise in the plasma oxytocin levels does not negate a role for oxytocin in working synergistically with prostaglandins in the mechanism of labor.

Amnion↗

PubMed1976

Reduction of the stretch modulus of human cervical tissue by prostaglandin E2.

Samples of cervical tissue were obtained from women immediately following term delivery from spontaneous labor or oral PGE2-induced labor and from a small nunber of nonpregnant women in the reproductive years undergoing hysterectomy for benign gynecologic disease. The measured strips were placed in a well-oxygenated bath at 37 degrees C. containing Ringer's solution and stretched at a constant rate while continuously recording length and tension. The data were converted to stress-strain diagrams. Each curve contained a long linear portion which allowed one to compute a stretch modulus for each sample. A total of 71 strips from 23 patients was used. The average stretch modulus from the oral PGE2-induced patients was significantly lower than the spontaneous labor group (p less than 0.005), which, in turn, was significantly lower than the stretch modulus of the nonpregnant cervical tissue. It was also noted that the yield point was lower in the PGE2 series when compared to the spontaneous labor series (p less than 0.05). The effect of the PGE2 at a bath concentration of 10(-5) to 10(-6)Gm. per cubic centimeter was to materially reduce the stretch modulus within 5 to 15 minutes of the drug addition in both the PGE2-induced and spontaneous labor series. The results of these experiments indicate that PGE2 has the effect of reducing cervial stiffness.

Cervix Uteri↗

PubMed2001

A high-throughput study of gene expression in preterm labor with a subtractive microarray approach.

OBJECTIVE: We propose that elucidation of the pathophysiology of preterm labor can be achieved with genome-scale analyses of differential gene expression. STUDY DESIGN: CD-1 mice on day 14.5 of a 19- to 20-day gestation were assigned to one of 4 treatment groups modeling different clinical conditions (n = 5 per group): group A, infection with labor (intrauterine injection of 10(10) heat-killed Escherichia coli, which causes delivery within an average of 20 hours); group B, infection without labor (intrauterine injection of 10(7) heat-killed E coli, which leads to normal delivery at term); group C, labor without infection (ovariectomy, which causes delivery within an average of 27 hours); and group D, no infection and no labor (intrauterine injection of vehicle). Total pooled myometrial RNA was prepared 3.5 hours after surgery for groups A, B, and D and 5 hours after surgery for group C. The relative expression of 4963 genes was assayed in these pools by using DNA microarrays. Transcripts specifically involved in infection-induced labor were identified by subtracting from the list of differentially regulated genes in group A those with common expression in groups B and C. RESULTS: In group A 68 differentially expressed transcripts (>or=2-fold upregulation or downregulation) were identified. Among these are 39 characterized genes. Fourteen (45%) are involved in inflammatory responses, 7 (18%) are involved in growth-differentiation-oncogenesis, and 3 (8%) are involved in apoptosis. Subtraction identified 13 gene products most likely to be important for bacterially induced labor, as opposed to labor without infection or bacterial exposure without labor. CONCLUSION: This study demonstrates the potential of the subtractive DNA microarray technique to identify transcripts important specifically for bacterially induced preterm labor.

Animals↗