Objective

To compare early induction and expectant management regarding delivery outcomes and the experience of delivery in nulliparous women with prolonged latent phases.



Design

Randomized controlled trial.



Setting

One delivery unit in a Swedish hospital.



Population

Nulliparous women at term experiencing continuous contractions impeding rest (women's report) and exceeding 18 h, a cervical dilation of less than 4 cm, intact membranes and with a singleton fetus in cephalic presentation.



Methods

The women were randomly allocated to either early induction (n = 65) or expectant management (n = 64). All participants received medication for therapeutic rest. The early induction group was induced five hours after medication, and the expectant group awaited spontaneous onset of labor. The Wijma Delivery Experience Questionnaire (W-DEQ version B) was filled in after delivery.



Main outcome measures

The primary outcome was mode of delivery. Secondary outcomes included birth experience, duration of labor, postpartum hemorrhage, and neonatal outcomes.



Results

The cesarean section rate was 15 of 65 (23.1%) in the early induction group and 24 of 64 (37.5%) in the expectant group (p = 0.076, OR 2.00, 95% CI 0.93–4.31). No significant differences were shown regarding delivery, neonatal outcomes or birth experience.



Conclusions

No significant differences were shown between the two groups in the rate of cesarean sections or the experience of delivery. According to the actual results, the power to detect a difference was only 45%. The cesarean section rate was high in both groups, regardless of intervention.

A randomized controlled trial on early induction compared to expectant management of nulliparous women with prolonged latent phases

Objective To analyze the maternal and fetal factors affecting emergency cesarean section (EmCS) and establish a risk scoring system to quantitatively predict the risk of EmCS. Design A total of 10,295 pregnant women were enrolled in this study. The influence of maternal and fetal factors on the risk of EmCS was analyzed. Results 991 (9.63%) cases of failed vaginal delivery received EmCS. The two main causes of EmCS were fetal distress (67.21%) and abnormal fetal position (14.93%). There were significant differences in 17 maternal and fetal factors between the normal vaginal delivery (NVD) and EmCS groups (p Conclusion An effective risk scoring system has been developed to quantitatively assess the risk of EmCS based on measurable maternal and fetal factors. The system is simple, easy to operate and has good repeatability in clinical practice.

https://jim.bmj.com/content/jim/68/3/799.full.pdf

Prediction of emergency cesarean section by measurable maternal and fetal characteristics.

Indications for operative delivery between 1999-2010 and induction of labor and epidural analgesia on the risk of operative delivery--a population based Swedish register study.

Objective: To compare the obstetrical outcomes of term pregnancies induced with one of four commonly used labor induction agents.Methods: This is a retrospective cohort study of induced deliveries between 1 August 1995 and 31 December 2007 occurring at the Los Angeles County + University of Southern California Medical Center. Viable, singleton, term pregnancies undergoing induction were identified. Exclusion criteria included gestational age less than 37 weeks, previous cesarean delivery, breech presentation, stillbirth, premature rupture of membranes, and fetal anomaly. Induction methods studied were oxytocin, misoprostol, dinoprostone and Foley catheter. Our primary outcome was cesarean delivery rate among the four induction agents. Secondary outcomes included rate of failed induction, obstetrical complications, and immediate neonatal complications.Results: A total of 3707 women were included in the study (1486 nulliparous; 2221 multiparous). Outcomes were compared across induction methods using...

A comparison of obstetrical outcomes with labor induction agents used at term.

The association between the regular use of preventive labour induction and improved term birth outcomes: findings of a systematic review and meta‐analysis

Objective. To assess the risk for emergency cesarean section among women in whom labor was induced in gestational week ≥41 and to evaluate if parity and mode of induction affected this association. Design. Hospital-based retrospective cohort study. Population. Singleton pregnancies delivered after ≥41 gestational weeks at Danderyd Hospital, Stockholm, Sweden, during 2002–2006. Material and methods. Of 23 030 singleton pregnancies meeting the entry criteria, 881 were induced with a Bishop score of <7. Obstetric outcome was assessed through linkage with the Swedish Medical Birth Registry and a local obstetrical database containing information from patients’ medical files. Results were adjusted for body mass index, age and the use of epidural analgesia. Main outcome measure. Risk for emergency cesarean section. Results. Among women who were induced, the proportions delivered by emergency cesarean section were 42% for nulliparous and 14% for multiparous. Compared to spontaneous onset, this corresponded to a more than threefold increase in risk for nulliparous women (OR 3.34, 95%CI 2.77–4.04) and an almost twofold increase in risk for multiparous women (OR 1.94, 95%CI 1.24–3.02). There was no significant difference in risk for emergency cesarean section between the two methods of induction (PGE2 and transcervical catheter). Conclusions. Compared to spontaneous onset of delivery, induction of labor is associated with an increased risk for emergency cesarean section both among nulliparous and multiparous women. When labor is induced, the high risk for emergency cesarean must be kept in mind.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-0412.2011.01213.x

Induction of labor and the risk for emergency cesarean section in nulliparous and multiparous women.

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Induction of labor and the risk for emergency cesarean section in nulliparous and multiparous women.