-
Current Opinion in Obstetrics &... Apr 2020Recent evidence supports elective induction of labor after 39 weeks; however, labor induction in patients with an unfavorable cervix, a Bishop score less than 6, may... (Review)
Review
PURPOSE OF REVIEW
Recent evidence supports elective induction of labor after 39 weeks; however, labor induction in patients with an unfavorable cervix, a Bishop score less than 6, may take several days. In this review, we focus on the efficacy and safety of methods of labor induction for the unfavorable cervix.
RECENT FINDINGS
Recent evidence on the use of mechanical cervical preparation with transcervical balloons suggests balloons are the most effective option for decreasing time to delivery in the nulliparous patient. Single and double balloons are equally effective, with a volume of more 30 ml being more effective. The addition of misoprostol or oxytocin concurrently with a balloon further expedites time to delivery.
SUMMARY
Mechanical dilation should be considered when available and technically possible for labor induction in patients with an unfavorable cervix. Misoprostol is an effective adjunct to trans-cervical balloons, further decreasing time to delivery as compared with balloon alone. When misoprostol is contraindicated, oxytocin is a safe, effective, alternative adjunct to trans-cervical balloons. More research is needed to evaluate safe outpatient options, induction methods in the setting of prior cesarean with an unfavorable cervix, and to directly compare misoprostol with oxytocin as adjuncts to transcervical balloons.
Topics: Catheterization; Cervical Ripening; Female; Humans; Labor, Induced; Oxytocics; Pregnancy; Prostaglandins; Randomized Controlled Trials as Topic; Time Factors
PubMed: 32004172
DOI: 10.1097/GCO.0000000000000608 -
Lancet (London, England) Dec 2023Oxytocin is effective in reducing labour duration but can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Oxytocin is effective in reducing labour duration but can be associated with fetal and maternal complications that could potentially be reduced by discontinuing the treatment during labour. We aimed to assess the impact of discontinuing oxytocin during active labour on neonatal morbidity.
METHODS
STOPOXY was a multicentre, randomised, open-label, controlled, superiority trial conducted in 21 maternity units in France. Participants who received oxytocin before 4 cm dilation were randomly assigned 1:1 to either discontinuous oxytocin (oxytocin infusion stopped beyond a cervical dilation equal to or greater than 6 cm) or continuous oxytocin (administration of oxytocin continued until delivery). Randomisation was stratified by centre and parity. The primary outcome, neonatal morbidity, was assessed at birth using a composite variable defined by an umbilical arterial pH at birth less than 7·10, a base excess greater than 10 mmol/L, umbilical arterial lactates greater than 7 mmol/L, a 5-min Apgar score less than 7, or admission to the neonatal intensive care unit. Efficacy and safety was assessed in participants who were randomly assigned (excluding those who withdrew consent or were deemed ineligible after randomisation) and had reached a cervical dilation of at least 6 cm. This trial is registered with ClinicalTrials.gov, NCT03991091.
FINDINGS
Of 2459 participants randomly assigned between Jan 13, 2020, and Jan 24, 2022, 2170 were eligible to receive the intervention and were included in the final modified intention-to-treat analysis. The primary outcome occurred for 102 (9·6%) of 1067 participants (95% CI 7·9 to 11·5) in the discontinuous oxytocin group and for 101 (9·2%) of 1103 participants (7·6 to 11·0) in the continuous oxytocin group; absolute difference 0·4% (95% CI -2·1 to 2·9); relative risk 1·0 (95% CI 0·8 to 1·4). There were no clinically significant differences in adverse events between the two groups of the safety population.
INTERPRETATION
Among participants receiving oxytocin in early labour, discontinuing oxytocin when the active phase is reached does not clinically or statistically significantly reduce neonatal morbidity compared with continuous oxytocin.
FUNDING
French Ministry of Health and the Département de la Recherche Clinique et du Développement de l'Assistance Publique-Hôpitaux de Paris.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Oxytocin; Oxytocics; Labor, Induced; Labor, Obstetric; Morbidity
PubMed: 37952548
DOI: 10.1016/S0140-6736(23)01803-2 -
Current Psychiatry Reports Aug 2017This review aims to evaluate the most recent literature examining the oxytocin (OXT) system's role in human anxiety by surveying various fields of preclinical and... (Review)
Review
PURPOSE OF REVIEW
This review aims to evaluate the most recent literature examining the oxytocin (OXT) system's role in human anxiety by surveying various fields of preclinical and clinical research supporting this role, and queries whether the OXT system might be a target for novel anxiolytics.
RECENT FINDINGS
Evidence from the diverse body of literature presented here, from translational research, genetic and neuroimaging studies, to clinical trials of intranasal (IN) OXT reveals a positive association. In addition, some moderators (e.g., sex, specificities to cues) of OXT's anxiolytic effects can have an important influence on its outcomes, awaiting further research. Evidence for the role of OXT in regulating anxiety is undeniable. We expect that the diverse particularities of the OXT system will help broaden our understanding of anxiety and stress-related disorders. We conclude that OXT promises an enticing treatment option for human anxiety disorders especially those associated with socio-emotional dysfunctions.
Topics: Anxiety Disorders; Humans; Oxytocics; Oxytocin; Translational Research, Biomedical
PubMed: 28808909
DOI: 10.1007/s11920-017-0819-1 -
International Journal of Gynaecology... Oct 2018Medical management of retained placenta could be a safe alternative to manual removal. (Comparative Study)
Comparative Study Review
BACKGROUND
Medical management of retained placenta could be a safe alternative to manual removal.
OBJECTIVE
To evaluate the efficacy of prostaglandin analogues for retained placenta.
SEARCH STRATEGY
MEDLINE, EMBASE, CENTRAL, ICTRP, LILACS, and OpenSIGLE were searched without language restrictions from inception to January 31, 2017, by combining terms for retained placenta and prostaglandin analogues.
SELECTION CRITERIA
Randomized controlled trials comparing prostaglandin analogues with any other intervention.
DATA COLLECTION AND ANALYSIS
Trials were independently assessed for inclusion, data extraction, and risk of bias. Data were extracted for meta-analyses. GRADE was used to evaluate the quality of data.
MAIN RESULTS
Seven randomized controlled trials (851 patients) were included. Prostaglandins did not increase the placenta expulsion rate (relative risk [RR] 1.40, 95% confidence interval [CI] 0.83-2.36) or decrease maternal transfusion (RR 0.72, 95% CI 0.43-1.22). In comparison with oxytocin, prostaglandins did not modify the expulsion rate (RR 1.26, 95% CI 0.90-1.78), maternal transfusion (RR 1.05, 95% CI 0.27-4.09), or time for delivery of placenta (mean difference -1.56 minutes, 95% CI, -9.25-6.13). Three trials comparing prostaglandins with oxytocin agonists, ergometrine, and manual removal reported similar results.
CONCLUSIONS
Prostaglandin analogues do not offer an effective alternative for management of retained placenta.
Topics: Ergonovine; Female; Humans; Oxytocics; Oxytocin; Placenta, Retained; Pregnancy; Prostaglandins, Synthetic; Randomized Controlled Trials as Topic
PubMed: 29939397
DOI: 10.1002/ijgo.12572 -
International Journal of Gynaecology... Jun 2015The effectiveness of Foley catheter plus misoprostol for cervical ripening has not been convincingly shown in trials. (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
The effectiveness of Foley catheter plus misoprostol for cervical ripening has not been convincingly shown in trials.
OBJECTIVES
To summarize the evidence comparing Foley catheter plus misoprostol versus misoprostol alone for cervical ripening.
SEARCH STRATEGY
Embase, Medline, and Cochrane Collaboration databases were searched with the terms "Foley catheter," "misoprostol," "cervical ripening," and "labor induction."
SELECTION CRITERIA
Randomized controlled trials comparing the methods of cervical ripening for delivery of a viable fetus were included.
DATA COLLECTION AND ANALYSIS
Study characteristics, quality, and outcomes were recorded. Random-effects models were used to combine data.
MAIN RESULTS
Eight trials were included, with 1153 patients overall. In a pooled analysis of seven high-quality studies, the combination group had a decreased time to delivery (mean difference -2.36 hours, 95% confidence interval [CI] -4.07 to -0.66; P=0.007). Risk of chorioamnionitis was significantly increased in the combination group (risk ratio [RR] 2.07, 95% CI 1.04-4.13; P=0.04), and that of tachysystole with fetal heart rate changes was decreased (RR 0.58, 95% CI 0.38-0.91; P=0.02). Frequency of cesarean did not differ (P=0.77).
CONCLUSIONS
The combined use of Foley catheter and misoprostol results in a reduced time to delivery, a reduced frequency tachysystole with fetal heart rate changes, and an increased incidence of chorioamnionitis.
Topics: Cervical Ripening; Chorioamnionitis; Delivery, Obstetric; Female; Humans; Misoprostol; Oxytocics; Pregnancy; Randomized Controlled Trials as Topic; Time Factors; Urinary Catheterization
PubMed: 25794821
DOI: 10.1016/j.ijgo.2015.01.005 -
Expert Opinion on Drug Safety Feb 2018Induction of labour is a commonly performed procedure around the world. There are various medications used for induction including those commonly used for cervical... (Review)
Review
INTRODUCTION
Induction of labour is a commonly performed procedure around the world. There are various medications used for induction including those commonly used for cervical ripening (prostaglandins) and oxytocin. The ideal agent is one that decreases the time to achieving delivery without compromising maternal or neonatal safety. The 'optimal safe agent' remains undetermined.
AREAS COVERED
This article reviews the safety of currently used induction agents. Prostaglandins and oxytocin have proven to be effective in labour induction, and their profiles will be reviewed in this article. We discuss the data that supports combining some of the agents. We also cover the safety of medications used for labour induction in setting of a scarred uterus.
EXPERT OPINION
There is continuous debate about the ideal induction agent: one that balances safety with efficacy. We recommend the practice that there is not one perfect agent for all, and that the clinical scenario and previous obstetric history should be considered before choosing an agent. In the future, pharmacogenomics may show that genetics may affect the individual response and adverse reactions to the various agents.
Topics: Cervical Ripening; Female; Humans; Infant, Newborn; Labor, Induced; Oxytocics; Oxytocin; Pregnancy; Prostaglandins
PubMed: 29141462
DOI: 10.1080/14740338.2018.1404573 -
Best Practice & Research. Clinical... Mar 2022Induction of labour is one of the most common interventions experienced by pregnant women. There are two overlapping components to labour induction, which include... (Review)
Review
Induction of labour is one of the most common interventions experienced by pregnant women. There are two overlapping components to labour induction, which include cervical ripening and the initiation of regular contractions. A large number of clinical studies have been conducted for evaluating the methods used for induction of labour, their effectiveness and safety, and pregnancy outcomes. Randomised controlled trials (RCTs) provide the strongest form of evidence for clinical practice. These data are brought together in systematic reviews and have been incorporated into national and international guidelines. Despite this, there is considerable variation in the recommendations between guidelines. Heterogeneity between studies, inconsistency in the definitions of trial outcomes, and underpowered sample size contribute to the difficulty in making robust recommendations. There are pharmacological and non-pharmacological approaches that can be compared with each other and with placebo or no treatment. There are also complementary therapies that may appeal to women but lack evidence of their effectiveness. These issues have been addressed in the current chapter, with a critical review of the research evidence presented in clinical trials and systematic reviews.
Topics: Cervical Ripening; Female; Humans; Labor, Induced; Oxytocics; Pregnancy; Systematic Reviews as Topic
PubMed: 34893438
DOI: 10.1016/j.bpobgyn.2021.11.008 -
European Journal of Obstetrics,... Aug 2014Induction of labour is the process of artificially initiating labour in order to end a pregnancy. We sought to explore changes in practice as documented in 'Ten... (Review)
Review
OBJECTIVES
Induction of labour is the process of artificially initiating labour in order to end a pregnancy. We sought to explore changes in practice as documented in 'Ten Teachers', an undergraduate textbook that was first published in 1917 and is now in its 19th edition.
STUDY DESIGN
The description of labour induction methods from each edition were described and tabulated.
RESULTS
Historically, the dangers of induction meant that it was only conducted in the event of life-threatening maternal disease. However, with improved methods, the threshold for intervention has reduced and it is now one of the most common interventions in pregnancy. Induction methods have changed over the last century from vaginal caesarean section, castor oil and De Ribes' bag at the start of the century to prostaglandins and oxytocin today.
CONCLUSIONS
Techniques for labour induction have changed markedly over the last century.
Topics: Female; Humans; Labor, Induced; Oxytocics; Pregnancy
PubMed: 24837027
DOI: 10.1016/j.ejogrb.2014.03.045 -
Archives of Gynecology and Obstetrics Jan 2019To assess the efficacy and safety of a double-balloon catheter versus dinoprostone insert for labour induction. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the efficacy and safety of a double-balloon catheter versus dinoprostone insert for labour induction.
STUDY DESIGN
PubMed, MEDLINE, Embase, ClinicalTrials.gov, and the Cochrane Central Register of Clinical Trials databases were searched from 1985 to April 2018. Randomized controlled trials that compared a double-balloon catheter and dinoprostone insert for cervical ripening were identified. Eligible study populations consisted of women with singleton pregnancies that had any indication for labour induction and were randomly assigned to undergo induction with a double-balloon catheter or dinoprostone insert. The main outcomes were incidence of vaginal delivery within 24 h and caesarean section, and neonatal outcomes.
RESULTS
Five randomized trials (603 women; 305 with a double-balloon catheter and 298 with a dinoprostone insert) were eligible for inclusion. No differences were observed between the two groups in terms of vaginal delivery within 24 h [relative risk (RR) 1.21, 95% confidence interval (CI) 0.93-1.59] and incidence of caesarean section (RR 0.99, 95% CI 0.77-1.27). Compared with the double-balloon catheter, the dinoprostone insert was associated with a reduced need for oxytocin administration in the process of labour induction (RR 1.95, 95% CI 1.45-2.62). However, there was a higher incidence of excessive uterine activity (RR 0.17, 95% CI 0.06-0.54) and neonatal umbilical cord arterial blood pH < 7.1 (RR 0.36, 95% CI 0.15-0.84) in the dinoprostone insert group.
CONCLUSION
This review showed that the efficacy of labour induction using both the double-balloon catheter and dinoprostone insert was similar. However, the double-balloon catheter seemed to be a safer method.
Topics: Adult; Catheters; Cervical Ripening; Cesarean Section; Delivery, Obstetric; Dinoprostone; Female; Humans; Labor, Induced; Oxytocics; Pregnancy; Randomized Controlled Trials as Topic; Treatment Outcome; Uterus
PubMed: 30315411
DOI: 10.1007/s00404-018-4929-8 -
American Family Physician Feb 2022
Topics: Cervical Ripening; Female; Humans; Labor, Induced; Outpatients; Oxytocics; Pregnancy
PubMed: 35166490
DOI: No ID Found