Online ISSN: 2515-8260

Keywords : Induction of labour


Comparision of Progression of Labour and Fetomaternal Outcome Between Spontaneous and Induced Labour

Kesavachandra Gunakala, P.M.Rekha Rao, Mude Vennela, Haneesha M.S

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 6045-6051

Background:Induction of labour is artificial initiation of uterine contractions prior to
spontaneous onset leading to progressive dilatation and effacement of cervix. Induction
of labour process whether by administering foley bulb induction, stripping, oxytocin
(or) prostaglandin. Labour induction is indicated where the benefits of either the
mother or fetus outweighs the benefit of continuing pregnancy. Aims and Objective:
The aim of the study is to analyze the progression of labour and comparison of fetal and
maternal outcome between spontaneous and induced labour.
Materials and Methods: Present study is a prospective comparative study involving 200
participants divided into induction (study) and spontaneous (control) groups. Data was
collected on socio demographic factors, maternal complications and fetal outcome
.Those women who had spontaneous onset of labour and reached >4cm of cervix
dilatation were included in study group. Progress of labour is monitored by modified
WHO partographs. Women on induction reached >4cm dilatation of cervix were
included in control group. Informed consent taken from every participant in the study.
Results: In the study group, the mean duration of active phase in primigravida was
6.2hours and in multigravida was 3.7hours. In control group, the mean duration of
active phase in primigravida was 4.7hours and in multigravida was 2.5hours.In study
group, the duration of second stage in primigravida and multigravida was 46minutes
and 25minutes respectively whereas in control group, it is 40 minutes for primigravida
and 21 minutes for multigravida. Induced labour is associated with higher cesarean
section rates. Cephalopelvic disproportion was the most common indication for
cesarean section followed by failed induction.
Conclusion: The mean duration of active phase and second stage of labour is longer in
study group compared to control group. Neonatal outcome was similar in both groups
except for 1minute and 5-minute APGAR scores which were significantly higher in
spontaneous group. Augmentation of labour is frequently required in study group
rather than control group. Occurrence of maternal complications like PPH, fever,
vomiting and hyperstimulation of uterus showed no significant difference in both the
groups.

Comparative study of efficacy and safety of mifepristone and Foley’s catheter in induction of labour

Dr. Amrutha AV, Dr. Shaila Chikkagowdra, Dr. Ravi Karad

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 2, Pages 2521-2528

Background: Labour Induction the most common Obstetric intervention done all over the world and where many methods are experimented for the same. Mifepristone, an antiprogestin effectively used for labour induction in term pregnancies is an upcoming area of interest. Foley’s bulb induction is an ancient and effective method as inducing agent, Misoprostol (PGE1) has been in use more effectively from 1990’s for Induction of labour. Since there is no single novel drug for induction, which is more effective and universally accepted, there is always scope for research. Hence this is a study undertaken to compare Mifepristone and Foley’s bulb in induction of labour.
Objectives:
1. To compare the efficacy and safety of mifepristone and Foley’s catheter insertion in induction of labor.
2. To compare the maternal and fetal outcome in both the groups.
Methodology: Prospective Randomized Control Trial undertaken in 100 pregnant women undergoing labour induction for various indications meeting the inclusion and exclusion criteria. Group A received Mifepristone 200mg PO, followed by 25mcg vaginal misoprostol 4th hourly for maximum of 4 doses and oxytocin accordingly deciding on Bishop’s score, In Group B Foley’s bulb inserted intracervically and inflated with 30ml of distilled water and followed similarly with misoprostol and oxytocin. Change in Bishop’s score, progress of labour induction to delivery interval, successful IOL and neonatal outcome noted.
Results: The primary outcomes were-
1. The improvement in Bishop’s score was similar in Mifepristone and Foley’s bulb group, i.e. 2.80 and 2.88 respectively.
2. Mean induction to delivery interval which is comparatively short in Mifepristone group (20.50hrs) compared to Foley’s bulb group (19.47hrs) and was found to be not statistically significant (P<0.001).
3. Successful IOL-Labour natural was maximum in Mifepristone group-68% compared to 62% in Foley’s group.
Conclusion: Foley’s catheter & Mifepristone are effective agents for cervical ripening which have comparable efficacy and negligible FETO-maternal side effects.

Elastography of the cervix for prediction of induction of labour

Dr. Sanjivani Wanjari; Dr. Suresh Phatak; Dr. Deepti Shrivastava

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 2, Pages 1936-1945

Abstract: Background –Labour can be induced for various indications. This is done when
it appears that benefits of induction outweigh its risk. Bishop score is the gold standard
that is used to determine whether labour can be induced. However, the assessment of the
cervix with digital examination is subjective and less reproducible. Elastography is an
upcoming modality which is an ultrasound-based imaging technique used for assessing
elasticity of tissues. It is based on the premise that softer tissues get more compressed than
harder tissues when pressure is applied with ultrasound probe. Thereafter colour mapping
is done depending on the gradient values of strain.
Aim - to assess whether elastography findings of uterine cervix can be used to predict
successful induction of labour.
Objectives -
1) To examine the cervix by digital examination.
2) To determine the length of the cervix with the help of trans-vaginal ultrasound.
3) To perform strain elastography of the cervix.
4) To observe within how many hours labour starts after induction.
Materials & methods –
A prospective observational study will be done at AVBRH over a three years period from
October 2018 to October 2021. Inclusion criteria - Pregnant women with gestation of 36-41
weeks, having no contraindication for labour induction, will be included in the study.
Sampling procedure –Simple Random Sampling. Sample size – estimated sample size for
study is 80 cases. Strain Elastography of the cervix will be performed before labour
induction in the sample population and the outcome will be assessed. A score will be
devised based on the colour mapping of elastography.
Results-
Up till now we have had encouraging results. A colour map showing various colours from
blue/purple through green/ yellow and then orange/red were noted. The colour red

ROLE OF CERVICAL LENGTH ASSESSMENT BY TRANSVAGINAL SONOGRAPHY IN PREDICTING THE SUCCESS OF LABOUR INDUCTION IN NEAR TERM WOMEN

SONALI CHAUHAN; DEEPTI SHRIVASTAVA

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 7, Pages 2174-2181

Background: Progressive cervical effacement, cervix dilatation and decent of the presenting part leading to vaginal delivery by iatrogenic uterine contractions of a healthy baby is known as induction of labour.
Cervical length measurement by transvaginal ultrasonography is more objective way for assessing cervical status In late pregnancy, measurement of length of the cervix could help in predicting the spontaneous onset of labour and could assist clinicians in assessing favourability for the induction of labour.
Aim: This aim to find the significance of length of cervical by transvaginal sonography in predicting the successful induction of labour in near term women.
Objectives:
1. To evaluate the cervical length by Transvaginal sonography. 2. To assess the progress of labour in women with different cervical length after induction by misoprostol tablets in relation to cervical length within 24 hours. 3. To assess the overall course of induction in terms of maternal and neonatal outcome.
Material and methods:
In the study, Near term women undergoing induction of labour, will be subjected to history taking, examination and required investigations. A formula is used to measure the sample size, which has the desired level of accuracy, the desired level of confidence, and the approximate proportion of the attribute in the population. Total study participants will be selected among term pregnant primigravida women admitted for delivery after screening through inclusion and exclusion criteria. Prior to the enrolment, written informed consent will be obtained from eligible participants. Selected cases will be subjected to trans-vaginal sonography for cervical length assessment and routine digital examination and then induction of labour will be done with misoprostol.
Expected Results: Women having smaller cervical length are expected to have more favourable outcome of induction in comparison to women with longer cervix near term.