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PubMed1994

Distention of the uterus activates its multiple pacemakers and induces their coordination.

In the pregnant human uterus, pacemaker activities and their coordination processes were studied in labor induced by uterine distention. Electrical and mechanical activities of the uterus were simultaneously recorded in 6 midtrimester (normal, n = 4; fetal death, n = 2) and 8 term (normal, n = 7; fetal death, n = 1) patients. Initially, frequent and sporadical spike discharges which did not synchronize with low magnitude and irregular mechanical activities were noted. With time, synchronization of both activities developed. These findings were noted regardless of the gestational stage of the patient and fetal viability. The patterns of development and decreases in mechanical and electrical activities, together with their synchronization patterns, were positively and negatively controlled by uterine distention and its suspension, respectively. These results suggest that the uterus has multiple pacemakers in various locations, and uterine distention works as a trigger for the elevation of excitability and for coordinated and orthodromic activities.

Adult↗

PubMed1985

The effect of vaginal administration of various doses of prostaglandin E2 gel on cervical ripening and induction of labor.

Eighty patients with a Bishop score of less than or equal to 4 were randomly administered vaginal triacetin gel containing placebo or prostaglandin E2 in 1, 2, and 3 mg doses. Twelve to sixteen hours later, those not in labor underwent oxytocin induction. Increasing doses of prostaglandin were effective in ripening the cervix, and the higher doses were associated with significant success in inducing labor.

Adult↗

PubMed2001

Rupture of an unscarred uterus with misoprostol induction: case report and review of the literature.

Uterine rupture is a serious and often tragic complication that is life threatening to both mother and child. It occurs at a frequency of around 1% in patients with a previously scarred uterus. Rupture of an unscarred uterus is an unexpected and devastating complication of pregnancy. With the increased use of misoprostol as a labor-inducing agent, cases of rupture of an unscarred uterus following its use have been published in the literature. We report a case of uterine rupture in a multigravid woman with an intrauterine fetal death at 29 weeks' gestation whose labor was induced with misoprostol. A review of all cases of uterine rupture with misoprostol induction is also included. Excessive doses of misoprostol should be used with extreme caution in multiparous women and in patients with a previously scarred uterus even in the context of intrauterine fetal death or termination of pregnancy.

Adult↗

PubMed2005

Bishop score and risk of cesarean delivery after induction of labor in nulliparous women.

OBJECTIVE: To quantify the risk and risk factors for cesarean delivery associated with medical and elective induction of labor in nulliparous women. METHODS: A prospective cohort study was performed in nulliparous women at term with vertex singleton gestations who had labor induced at 2 obstetrical centers. Medical and elective indications and Bishop scores were recorded before labor induction. Obstetric and neonatal data were analyzed and compared with the results in women with a spontaneous onset of labor. Data were analyzed using univariate and multivariable regression modeling. RESULTS: A total of 1,389 women were included in the study. The cesarean delivery rate was 12.0% in women with a spontaneous onset of labor (n = 765), 23.4% in women undergoing labor induction for medical reasons (n = 435) (unadjusted odds ratio [OR] 2.24; 95% confidence interval [CI] 1.64-3.06), and 23.8% in women whose labor was electively induced (n = 189) (unadjusted OR 2.29; 95% CI 1.53-3.41). However, after adjusting for the Bishop score at admission, no significant differences in cesarean delivery rates were found among the 3 groups. A Bishop score of 5 or less was a predominant risk factor for a cesarean delivery in all 3 groups (adjusted OR 2.32; 95% CI 1.66-3.25). Other variables with significantly increased risk for cesarean delivery included maternal age of 30 years or older, body mass index of 31 or higher, use of epidural analgesia during the first stage of labor, and birth weight of 3,500 g or higher. In both induction groups, more newborns required neonatal care, more mothers needed a blood transfusion, and the maternal hospital stay was longer. CONCLUSION: Compared with spontaneous onset of labor, medical and elective induction of labor in nulliparous women at term with a single fetus in cephalic presentation is associated with an increased risk of cesarean delivery, predominantly related to an unfavorable Bishop score at admission. LEVEL OF EVIDENCE: II-2.

Adult↗

PubMed1999

Cervical ripening.

Induction of labor is indicated when the benefits to either the mother or the fetus outweigh the benefits of continuing the pregnancy. The state of the cervix is clearly related to the success of labor induction and the duration of labor. In cases of unfavorable cervices, physicians usually use a ripening agent before inducing labor. Unfortunately, as reviewed in this article, the ideal ripening agent is not found yet. No method of cervical ripening has shown a consistent and significant reduction in CS rate. In fact, women with the most unfavorable cervices (Bishop score, < or = 2) still face high rates of induction failure and CS.

Abortifacient Agents, Steroidal↗

PubMed1988

[Maturation of the cervix before the induction of labor after 36 weeks' amenorrhea. Apropos of our experience with a method of intra-cervical perfusion of PGE2].

This study evaluates the possibility of cervix maturation before inducing labor in women with premature rupture of the membranes after 36 weeks of amenorrhea, which was not followed by spontaneous labor and in whom cervical evaluation did not allow immediate induction by intravenous ocytocics or prostaglandin. The intracervical perfusion of PGE2 seems effective and perfectly tolerated in this indication, enabling to prevent infectious complications, the risk of which is increasing as time goes by.

Cervix Uteri↗

PubMed1990

Inositol 1,4,5-trisphosphate and oxytocin binding in human myometrium.

The presence of inositol 1,4,5-trisphosphate (IP3) receptors in human myometrium has been investigated and their concentration compared with that of oxytocin receptors. Myometrial microsomes were incubated with 3H-IP3 alone and in the presence of unlabeled IP3. Binding was to a single class of noninteracting sites with a density of 1-2 pmol/mg of protein. The sites had characteristics of true IP3 receptors, i.e., very fast association and dissociation rates, high affinity (Kd 25-50 nM) and specificity (IP3 greater than IP3[2,4,5], IP4 much greater than IP5 greater than IP3[1,3,4], IP1, IP2, IP6), and did not metabolize 3H-IP3. The binding was maximal at pH 8, and was inhibited by calcium (IC50 = 80 nM), magnesium (IC50 = 100 microM), heparin (IC50 = 4.5 micrograms/ml), and GTP (IC50 = 150 microM). The concentration and affinity of IP3 receptors were similar in pregnant and nonpregnant myometrium and remained constant during labor. By contrast, the density of oxytocin receptor increased significantly from nonpregnant to pregnant tissue and fell in advanced spontaneous labor but not in advanced induced labor. These results provide new, additional evidence for the involvement of the phosphatidylinositol pathway in the control of uterine contractility.

Binding, Competitive↗

PubMed2000

Nonpharmacologic approaches to cervical priming and labor induction.

Nonpharmacologic and alternative methods of cervical ripening are highly efficacious, safe, and, in general, have more favorable cost advantages when compared with their pharmacologic counterparts. Unfortunately, there have been limited research efforts to precisely determine the overall usefulness and the most clinically efficient application for many of these. These methods also share similar time courses to affect cervical change and are, in general, not as rapid as pharmacologic applications. Thus, limitations of time may ultimately determine the choice between alternative methods and pharmacologic modalities. Most of these alternative methods require more than 12 to 18 hours, and some even days to accomplish favorable changes in the cervix to promote ripening and subsequent labor initiation. These methods have also been shown to be efficient and safe, the most important criteria for any ripening agent, for both the maternal and fetal compartments. These alternative methods will continue to occupy an appropriate place in the armamentarium of cervical ripeners and labor-inducing agents.

Cervical Ripening↗

PubMed2001

Preinduction sonographic measurement of cervical length in the prediction of successful induction of labor.

BACKGROUND: Induction of labor is carried out in approximately 20% of pregnancies. However, approximately 20% of women having induction of labor end up having a Cesarean delivery. The traditional method of predicting whether an induced labor will result in successful vaginal delivery is based on the preinduction "favorability" of the cervix as assessed by the Bishop score. However, this assessment is subjective and several studies have shown a poor predictive value for the outcome of induction. OBJECTIVES: To examine the relationship between preinduction sonographically measured cervical length and the Bishop score and to compare the two measurements in the prediction of successful vaginal delivery within 24 h of induction. METHODS: In this multicenter study, preinduction cervical assessment was undertaken in 240 women with singleton pregnancies at 37-42 weeks of gestation. The Bishop score was assessed by digital examination and the cervical length was measured by transvaginal sonography. RESULTS: Multiple regression analysis demonstrated that cervical length, Bishop score and parity provided independent contribution in the prediction of the likelihood of delivering vaginally within 24 h. Further examination of the different components of the Bishop score showed that only cervical length provided a significant contribution in the prediction of the likelihood of vaginal delivery within 24 h. In the receiver operating characteristic curves, the best cut-off point for the prediction of successful induction was 28 mm for cervical length and 3 for the Bishop score. However, cervical length appears to be a better predictor than the Bishop score, with a sensitivity of 0.87 and a specificity of 0.71 compared to 0.58 and 0.77, respectively. Similarly, the Kaplan-Meier survival curves indicate that better discriminatory results in the prediction of vaginal delivery within 24 h are achieved using cervical length rather than the Bishop score. CONCLUSION: Transvaginal sonographic measurement of cervical length provides a useful prediction of the likelihood of vaginal delivery within 24 h of induction.

Cervix Uteri↗

PubMed1993

Prevention of cesarean section. Does intracervical dinoprostone work?

We investigated the effect of preinduction cervical ripening with the intracervical instillation of dinoprostone (prostaglandin E2 gel, 0.5 mg) on the results of labor induced with intravenous oxytocin. We randomly allocated 79 pregnant women to receive either the intracervial application of dinoprostone gel or placebo gel. Compared with control subjects, the group who received dinoprostone had no difference in induction-to-delivery interval or in cesarean section rate. The dinoprostone group had fewer failed inductions, but there was no difference between the two groups in the number who delivered spontaneously within 24 hours. From review of the literature and a meta-analysis, it was likewise revealed that dinoprostone did not favorably affect the cesarean section rate. Contrary to current opinion, intracervical dinoprostone gel does not appreciably lower the cesarean section rate when used at this dose and route before labor is induced.

Administration, Intravaginal↗

PubMed1979

Spontaneous labor and elective induction--a prospective randomized study. I. Effects on mother and fetus.

In a prospective randomized study spontaneous and oxytocin induced labor "for convenience" have been compared with respect to uterine activity, duration of labor, the condition of the fetus and the newborn infant. The study consists of 84 normal patients, of whom 43 were induced at full term by amniotomy and oxytocin infusion using the Cardiff Infusion System Mark II; 41 patients served as controls. No difference in maternal age, number of previous pregnancies and pelvic score one week before the day of delivery were found between the groups. The following parameters were calculated: duration of labor, uterine activity, amount of bleeding in the third stage of labor, number of early and late decelerations as well as number of episodes of bradycardia in the CTG-recordings, birth weight, Apgar score one and five minutes post-delivery and blood gases in mother and child 60 seconds after delivery. No significant differences between the two groups were found. It is concluded that there are no increased risks to mother or fetus compared to normal labor provided that there is cephalic presentation and normal pregnancy, careful selection with respect to the length of pregnancy and the condition of the cervix and that the Cardiff infusion system is used with intrauterine pressure recording and continuous fetal heart monitoring.

Adolescent↗

PubMed2005

Oral, vaginal and sublingual misoprostol for induction of labor.

OBJECTIVE: To evaluate the effectiveness and safety of different administration routes of misoprostol for induction of labor. METHOD: PubMed, Cochrane Library and EMBASE searches were carried out using the keywords oral, vaginal, sublingual, buccal, misoprostol, labor induction, identifying randomized case-controlled trials comparing different routes for giving misoprostol to induce labor, published in English between 1994 and 2004. RESULTS: Seventeen studies (3549 participants) were included. Compared to vaginal administration, oral misoprostol was associated with higher failure rates for achieving vaginal delivery within 24 h (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.23-2.10), higher rates of uterine hyperstimulation without fetal heart rate (FHR) changes (OR 2.21, 95% CI 1.12-4.34) and lower cesarean section rates (OR 0.74, 95% CI 0.56-0.97). A lower dose of oral misoprostol (50 microg) compared to the 25-50 microg administered vaginally was associated with a higher rate of vaginal delivery not being achieved within 24 h (OR 3.60, 95% CI 2.10-6.18), more need for oxytocin augmentation (OR 2.19, 95% CI 1.65-2.92), less uterine hyperstimulation both without FHR changes (OR 0.58, 95% CI 0.42-0.80) and with FHR changes (OR 0.34, 95% CI 0.17-0.67) and fewer cesarean sections (OR 0.69, 95% CI 0.51-0.91). Compared to vaginal administration, buccal misoprostol resulted in a higher rate of failure to achieve vaginal delivery after 24 h, more frequent uterine hyperstimulation and lower rates of cesarean section, but these differences were not significant. When 50 mug of misoprostol used sublingually was compared to oral administration, the sublingual misoprostol was associated with less failure to achieve vaginal delivery after 24 h, less oxytocin augmentation and reduced cesarean section, but none of the differences were statistically significant. CONCLUSIONS: Vaginal misoprostol appears more effective than the equivalent dosage administered orally. However, the vaginal route appears to be associated with a higher risk of uterine hyperstimulation. Sublingual misoprostol seems an effective route of administration, but a lack of data necessitates more clinical trials to establish the effectiveness and safety of the buccal/sublingual route.

Administration, Oral↗

PubMed1990

A comparative randomized study of oral prostaglandin E2 (PGE2) tablets and intravenous oxytocin in induction of labor in patients with premature rupture of membranes before 37 weeks of pregnancy.

In a randomized prospective study, we compared the use of intravenous oxytocin with oral PGE2 tablets for stimulation of labor in cases of premature rupture of membranes (PROM) before term, where the onset of spontaneous labor did not occur within the first 3 h. This study represents the first of its kind in which oral PGE2 and oxytocin have been directly compared as oxytocic agents for PROM before 37 weeks. Labor induction was successful in 96% of patients in the PGE2 group compared with 84% in the oxytocin group. The incidence of cesarean section (CS) was 5% and 16% in the PGE2 and the oxytocin groups, respectively. While 10% of the CS were performed due to fetal bradycardia in the oxytocin group, none was performed in the PGE2 group despite the fact that the latter group had relatively lower Bishop scores. The data presented indicate that oral PGE2 is safe and effective in initiating active labor in healthy women at pre-term with PROM. Thus we recommend its use to induce labor 3 h after rupture of membranes before 37 weeks gestation.

Administration, Oral↗

PubMed1981

Single application of prostaglandin E2 in a viscous gel for induction of labor at term in patients with favorable cervix.

A single dose of 0.5 mg prostaglandin E2 in viscous gel was administered intracervically to induce labor in 150 patients with a favorable cervix. All but 5 patients (97 per cent) were delivered within 12 hours. No adverse maternal or fetal effects were registered. The method, which enables induction without primary amniotomy, was easy to perform and well accepted by the patients.

Adolescent↗

PubMed1994

Use of the Foley catheter as a cervical ripening agent prior to induction of labor.

OBJECTIVE: To study the effect of the extraamniotic Foley catheter as a cervical ripening agent prior to induction of labor. METHOD: A descriptive study was carried out on 187 patients who had labor induced following cervical ripening with the extraamniotic Foley catheter. There were 99 nulliparas and 88 multiparas whose labor outcomes were analyzed separately. RESULTS: The mean change in the modified Bishop score was 3.7 for nulliparas and 3.3 for multiparas. The induction-delivery interval was 8.7 h for nulliparas and 5.5 h for multiparas. CONCLUSION: The Foley catheter was found to be an effective agent for cervical ripening in both primiparas and multiparas and its use was not associated with any complications.

Adult↗

PubMed1976

A technique for the induction of labor by the extraovular administration of prostaglandin F2alpha.

Prostaglandin F2alpha (PG F2alpha) was administered to pregnant women at a dosage of 50 microng or 100 microng by extraovular route around the expected time of childbirth in order to induce labor. (1) PG F2alpha 50 microng or 100 microng dissolved in 10 ml of physiological saline solution was infused by extraovular administration through the cervical canal of the uterus with the use of Nelaton catheter No. 9. The catheter was then immediately withdrawn and the patient allowed to return home. (2) Instilation of 10ml of physiological saline solution was carried out for control purposes. (3) Those who reported labor contractions within 24 hours after the infusion were regarded as cases of excellent response, and those who reported labor contractions more than 24 hours after the infusion, or those who showed dilatation and improvement in effacement of the uterine cervical canal though without the occurrence of labor contractions were deemed to be cases of good response. The overall positive response rate (excellent plus good) was 78.9% for primiparae and 85.7% for multiparae in the group receiving 50 microng and 89.5% for primiparae and 100% for multiparae in the group receiving 100 microng. (4) Labor contraction were induced at a rate of almost 100% in those who showed dilatation of the cervical canal of the uterus to the extent of 3 cm or more and effacement to the extent of 50% or more. (5) It is advisable to perform reinfusion of PG F2alpha or instilation of PG F2alpha as a post-treatment in patients with good responses. (6) The infusion of PG F2alpha is effective for the induction of labor in older primiparae, cases of breech presentation and suspected cases of CPD. (7) There were some cases of enhanced response when PG F2alpha was given as posttreatment.

Cervix Uteri↗

PubMed1992

[Investigation of maternal peripheral plasma concentration of PG in induction of labor by nutrition food inductive drug].

The used nutrition food inductive drug to induce labor in 33 pregnant women, 22 of 33 succeeded and 11 failed. The PGs level in maternal peripheral blood was measured twice. One before taking and the second sample was drawn blood during second stage of labor. Another 13 pregnant women of spontaneous labor were measured as control group. The 6-keto-PGF1 alpha level was significantly increased in the succeeding group than in the tailed induced group, the PGE concentration seems no significant change in these three groups. The data suggested that the nutritional food inductive drug may accelerate the synthesis of prostaglandin in the succeeding group.

6-Ketoprostaglandin F1 alpha↗

PubMed1992

[Management of the scarred uterus].

On the basis of 899 cases of uterine scarring following cesarean section, the authors carried out a prophylactic cesarean in 42% of cases. Labor ended in childbirth by the genital tract in 44% of cases. The very low incidence of uterine rupture since segmental hysterotomy has become widespread and the improved fetal and maternal prognosis are all reasons to prefer delivery by the genital tract. One of the factors in choosing the method of childbirth is radiopelvimetry and estimation of the fetal weight; however, the suspicion of a threshold pelvis is not a contraindication to the labor test which was successful in 70% of the authors cases. On condition that strict obstetrical monitoring is possible, oxytocic drugs can be used to induce labor or correct hypokinesia and to administer a peridural analgesic. Routine extraction is no longer necessary during the expulsion phase but the authors remain faithful to uterine revision. In general, the labor test should be suggested as often as possible and should receive the same monitoring and treatment methods as for an intact uterus.

Birth Weight↗