Download or read book Maternal and Neonatal Outcomes of Elective Induction of Labor written by and published by . This book was released on 2009 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Induction of labor is on the rise in the U.S., increasing from 9.5 percent in 1990 to 22.1 percent in 2004. Although, it is not entirely clear what proportion of these inductions are elective (i.e. without a medical indication), the overall rate of induction of labor is rising faster than the rate of pregnancy complications that would lead to a medically indicated induction. However, the maternal and neonatal effects of induction of labor are unclear. Many studies compare women with induction of labor to those in spontaneous labor. This is problematic, because at any point in the management of the woman with a term gestation, the clinician has the choice between induction of labor and expectant management, not spontaneous labor. Expectant management of the pregnancy involves nonintervention at any particular point in time and allowing the pregnancy to progress to a future gestational age. Thus, women undergoing expectant management may go into spontaneous labor or may require indicated induction of labor at a future gestational age. OBJECTIVES: The Stanford-UCSF Evidence-Based Practice Center examined the evidence regarding four Key Questions: 1) What evidence describes the maternal risks of elective induction versus expectant management? 2) What evidence describes the fetal/neonatal risks of elective induction versus expectant management? 3) What is the evidence that certain physical conditions/patient characteristics are predictive of a successful induction of labor? and 4) How is a failed induction defined? METHODS: We performed a systematic review to answer the Key Questions. We searched MEDLINE(r) (1966-2007) and bibliographies of prior systematic reviews and the included studies for English language studies of maternal and fetal outcomes after elective induction of labor. We evaluated the quality of included studies. When possible, we synthesized study data using random effects models. We also evaluated the potential clinical outcomes and cost-effectiveness of elective induction of labor versus expectant management of pregnancy labor at 41, 40, and 39 weeks' gestation using decision-analytic models. RESULTS: Our searches identified 3,722 potentially relevant articles, of which 76 articles met inclusion criteria. Nine RCTs compared expectant management with elective induction of labor. We found that overall, expectant management of pregnancy was associated with an approximately 22 percent higher odds of cesarean delivery than elective induction of labor (OR 1.22, 95 percent CI 1.07-1.39; absolute risk difference 1.9, 95 percent CI: 0.2-3.7 percent). The majority of these studies were in women at or beyond 41 weeks of gestation (OR 1.21, 95 percent CI 1.01-1.46). In studies of women at or beyond 41 weeks of gestation, the evidence was rated as moderate because of the size and number of studies and consistency of the findings. Among women less than 41 weeks of gestation, there were three trials which reported no difference in risk of cesarean delivery among women who were induced as compared to expectant management (OR 1.73; 95 percent CI: 0.67-4.5, P=0.26), but all of these trials were small, non-U.S., older, and of poor quality. When we stratified the analysis by country, we found that the odds of cesarean delivery were higher in women who were expectantly managed compared to elective induction of labor in studies conducted outside the U.S. (OR 1.22; 95 percent CI 1.05-1.40) but were not statistically different in studies conducted in the U.S. (OR 1.28; 95 percent CI 0.65-2.49). Women who were expectantly managed were also more likely to have meconium-stained amniotic fluid than those who were electively induced (OR 2.04; 95 percent CI: 1.34-3.09). Observational studies reported a consistently lower risk of cesarean delivery among women who underwent spontaneous labor (6 percent) compared with women who had an elective induction of labor (8 percent) with a statistically significant decrease when combined (OR 0.63; 95 percent CI: 0.49-0.79), but again utilized the wrong control group and did not appropriately adjust for gestational age. We found moderate to high quality evidence that increased parity, a more favorable cervical status as assessed by a higher Bishop score, and decreased gestational age were associated with successful labor induction (58 percent of the included studies defined success as achieving a vaginal delivery anytime after the onset of the induction of labor; in these instances, induction was considered a failure when it led to a cesarean delivery). In the decision analytic model, we utilized a baseline assumption of no difference in cesarean delivery between the two arms as there was no statistically significant difference in the U.S. studies or in women prior to 41 0/7 weeks of gestation. In each of the models, women who were electively induced had better overall outcomes among both mothers and neonates as estimated by total quality-adjusted life years (QALYs) as well as by reduction in specific perinatal outcomes such as shoulder dystocia, meconium aspiration syndrome, and preeclampsia. Additionally, induction of labor was cost-effective at $10,789 per QALY with elective induction of labor at 41 weeks of gestation, $9,932 per QALY at 40 weeks of gestation, and $20,222 per QALY at 39 weeks of gestation utilizing a cost-effectiveness threshold of $50,000 per QALY. At 41 weeks of gestation, these results were generally robust to variations in the assumed ranges in univariate and multi-way sensitivity analyses. However, the findings of cost-effectiveness at 40 and 39 weeks of gestation were not robust to the ranges of the assumptions. In addition, the strength of evidence for some model inputs was low, therefore our analyses are exploratory rather than definitive. CONCLUSIONS: Randomized controlled trials suggest that elective induction of labor at 41 weeks of gestation and beyond may be associated with a decrease in both the risk of cesarean delivery and of meconium-stained amniotic fluid. The evidence regarding elective induction of labor prior to 41 weeks of gestation is insufficient to draw any conclusion. There is a paucity of information from prospective RCTs examining other maternal or neonatal outcomes in the setting of elective induction of labor. Observational studies found higher rates of cesarean delivery with elective induction of labor, but compared women undergoing induction of labor to women in spontaneous labor and were subject to potential confounding bias, particularly from gestational age. Such studies do not inform the question of how elective induction of labor affects maternal or neonatal outcomes. Elective induction of labor at 41 weeks of gestation and potentially earlier also appears to be a cost-effective intervention, but because of the need for further data to populate these models our analyses are not definitive. Despite the evidence from the prospective, RCTs reported above, there are concerns about the translation of such findings into actual practice, thus, there is a great need for studying the translation of such research into settings where the majority of obstetric care is provided.

Download or read book Maternal and Neonatal Outcomes of Elective Induction of Labor written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-05-31 with total page 262 pages. Available in PDF, EPUB and Kindle. Book excerpt: Induction of labor is increasing in the U.S. The overall induction rate has increased from 9.5 percent in 1990 to 22.1 percent in 2004. Induction of labor that is not indicated for a medical reason, also termed elective induction of labor, appears to be rising as well and at a rate even more rapidly than that of the overall induction of labor. Elective induction may be motivated by a variety of reasons. For example, pregnant women may wish to end their pregnancy because of physical discomfort, concern for rapidly progressing labor precluding timely arrival at the hospital or epidural placement, scheduling issues, or ongoing concerns for maternal, fetal, or neonatal complications. Clinicians who care for pregnant women (e.g., obstetricians, family-practice physicians, midwives) may have similar non-medical reasons for choosing elective induction of labor for their patients. They, too, may wish to end their patients' physical discomfort or have concerns about either distance from the hospital or ongoing risk in the pregnancy. However, clinicians may also be incentivized to utilize elective induction for their own financial benefit and scheduling preferences. Thus, it is imperative to determine the potential outcomes associated with elective induction of labor. Elective induction of labor necessarily reduces some risks of an ongoing pregnancy. Such risks include developing preeclampsia, oligohydramnios, macrosomia, or intrauterine fetal demise at a later gestational age. However, the commonly held dogma regarding induction of labor is that it increases the risk of cesarean delivery, which in turn is associated with a host of maternal complications. Additionally, a cesarean delivery in the current pregnancy increases both maternal and neonatal risks in future pregnancies. Thus, determining the effect of elective induction of labor on cesarean delivery as well as other maternal and neonatal outcomes is important. When evaluating the risks and benefits of elective induction of labor, it is essential that women having elective induction of labor be compared to women having expectant management of labor. Expectant management of the pregnancy involves nonintervention at any particular point in time and allowing the pregnancy to progress to a future gestational age. Thus, the woman undergoing expectant management may go into spontaneous labor or may require indicated induction of labor at a future gestation due to developing preeclampsia, nonreassuring antenatal testing, or post term pregnancy. One methodologic problem with many studies of induction of labor, particularly observational studies, is that they often use women in spontaneous labor as a control group. This is problematic because at any point in the term pregnancy the clinician has the choice between induction of labor and expectant management, not spontaneous labor. Since increasing gestational age itself is associated with cesarean delivery, these studies are fundamentally flawed and can lead to misleading conclusions. With this background in mind, we sought to conduct a systematic review and decision analysis utilizing the existing literature in order to answer several questions regarding the effects of elective induction of labor. Specifically, we sought to answer the following Key Questions: Key Question 1: What evidence describes the maternal risks of elective induction versus expectant management? Key Question 2: What evidence describes the fetal/neonatal risks of elective induction versus expectant management? Key Question 3: What is the evidence that certain physical conditions/patient characteristics (e.g., parity, cervical dilatation, previous pregnancy outcome) are predictive of a successful induction of labor? Key Question 4: How is failed induction defined?

Download or read book Birth Settings in America written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2020-05-01 with total page 369 pages. Available in PDF, EPUB and Kindle. Book excerpt: The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.

Download or read book Maternal and Neonatal Outcomes Following Elective Induction of Labor with Oxytocin and Spontaneous Labor written by Kathleen M. Marcinek and published by . This book was released on 1996 with total page 200 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book WHO recommendations on induction of labour at or beyond term written by World Health Organization and published by World Health Organization. This book was released on 2022-10-06 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt: The updated recommendations in this document on the timing of induction of labour supersede the previous WHO recommendations on this topic, in the 2018 publication WHO recommendations: induction of labour at or beyond term.

Download or read book Elective Induction of Labor and Associated Adverse Outcomes to Mother and Baby written by Michele Jakowinicz and published by . This book was released on 2013 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Elective induction of labor is on the rise and has been for many years. In the past 10 years the induction rate has increased to 43.6% from 9.5% (Ohnsorg and Schiff, 2010). Studies reveal that many adverse outcomes such as unnecessary cesarean sections, operative vaginal deliveries, hemorrhaging, and admissions to the neonatal intensive care unit are associated with induction of labor; therefore waiting for spontaneous labor to begin in most cases is preferred. Many hospitals and facilities do not have clear elective induction policies in place, despite the abundant amount of evidence that supports waiting until the 39th completed week of gestation before electively inducing labor. This proposal represents the following question. In pregnant women (P), does elective induction of labor (I) compared to spontaneous labors (C) increase the rate of negative outcomes such as maternal and neonatal morbidity, cesarean sections and hemorrhage (O) at the time of delivery (T)? Encompassed within this paper is the establishment of an elective induction policy and protocols for determining medical versus elective inductions and the required criteria needed to meet these standards. A monthly auditing tool has been developed to collect and trend the data obtained for all inductions. It will be necessary for staff involved with the scheduling of inductions and those educating patients to adopt a new way of thinking in order to make this change a success. The change theory by Kurt Lewin will be used to implement this new plan. With the participation of the unit staff and physicians the changes involved with this induction of labor policy will invariably lead to increased safety and wellbeing for both mother and baby.

Download or read book Cervical Ripening and Induction and Augmentation of Labor written by Kathleen Rice Simpson and published by . This book was released on 1998 with total page 52 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Elective Induction Versus Spontaneous Labor written by Tracey L. Williams and published by . This book was released on 2002 with total page 126 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book WHO Recommendations on Intrapartum Care for a Positive Childbirth Experience written by World Health Organization and published by World Health Organization. This book was released on 2018-06-25 with total page 210 pages. Available in PDF, EPUB and Kindle. Book excerpt: This up-to-date comprehensive and consolidated guideline on essential intrapartum care brings together new and existing WHO recommendations that when delivered as a package will ensure good-quality and evidence-based care irrespective of the setting or level of health care. The recommendations presented in this guideline are neither country nor region specific and acknowledge the variations that exist globally as to the level of available health services within and between countries. The guideline highlights the importance of woman-centred care to optimize the experience of labour and childbirth for women and their babies through a holistic human rights-based approach. It introduces a global model of intrapartum care which takes into account the complexity and diverse nature of prevailing models of care and contemporary practice. The recommendations in this guideline are intended to inform the development of relevant national- and local-level health policies and clinical protocols. Therefore the target audience includes national and local public health policy-makers implementers and managers of maternal and child health programmes health care facility managers nongovernmental organizations (NGOs) professional societies involved in the planning and management of maternal and child health services health care professionals (including nurses midwives general medical practitioners and obstetricians) and academic staff involved in training health care professionals.

Download or read book Disease Control Priorities Third Edition Volume 2 written by Robert Black and published by World Bank Publications. This book was released on 2016-04-11 with total page 419 pages. Available in PDF, EPUB and Kindle. Book excerpt: The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.

Download or read book A Safer Policy written by Erin Turner and published by . This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Based on documented research studies, the risk for maternal and fetal complications due to the elective induction of labor process is much higher compared to the onset of spontaneous labor. Most facilities in the United States allow pregnant women with lowrisk pregnancies to choose elective induction of labor at 39 weeks' gestation. This process is increasing in popularity at an alarming rate among pregnant women in the United States, which, in turn, is resulting in more complications to mothers and infants. Research has indicated the benefits, to both mothers and their infants, in waiting for spontaneous labor to commence instead of initiating the induction process when there is no medical reason to induce labor. Establishing an elective induction of labor policy that requires adding at least one more week gestation to the pregnancy will reduce the number of complications because more women will go into spontaneous labor. Requiring a woman to be at least 40 weeks' gestation will increase the number of spontaneous labors and decrease the need for as many elective inductions and medical interventions. A decrease in the number of elective inductions will decrease the number of complications, including Cesarean section deliveries, maternal hemorrhage, maternal and fetal infections, fetal intolerance of labor, infant birth injuries, lower APGAR scores, more Neonatal Intensive Care Unit (NICU) admissions for infants, increased length of hospitalization, and higher health care costs. Implementing an organized and consistent elective induction of labor policy at 40 weeks' gestation or longer will ensure better overall outcomes for mothers and infants.

Download or read book 50 Studies Every Obstetrician Gynecologist Should Know written by Constance Liu and published by Oxford University Press. This book was released on 2021-02-19 with total page 352 pages. Available in PDF, EPUB and Kindle. Book excerpt: 50 Studies Every Obstetrician-Gynecologist Should Know presents key studies that have shaped the practice of obstetrics and gynecology. Selected using a rigorous methodology, the studies cover topics including hypertension in pregnancy, infectious diseases of pregnancy, family planning, urogynecology, and more. For each study, a concise summary is presented with an emphasis on the results and limitations of the study, and its implications for practice. An illustrative clinical case concludes each review, followed by brief information on other relevant studies. This book is a must-read for obstetrician-gynecologists, internists, family practitioners, nurse practitioners, and midwives, as well as anyone who wants to learn more about the data behind clinical practice.

Download or read book The Relationship of Bishop Score to Maternal and Fetal Complications in the Elective Induction of Labor written by Belinda Beshi and published by . This book was released on 2013 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt: Problem: There is paucity of evidence in the safety of elective labor induction with regards to the rate of cesarean delivery and neonatal NICU admissions. Few studies stratify study subjects by Bishop score, a factor that may play a major role in induced labor resulting in a cesarean delivery. Methods: The medical literature was searched using the Weill Cornell Medical College Library online PubMed database for articles that studied elective labor induction compared with spontaneous labor or expectant management, and the dangers/benefits of elective labor induction. Results: Some studies concluded that there is no statistically significant difference in maternal and neonatal morbidity based on the mode of delivery when comparing elective induction with spontaneous labor. Other studies concluded that there is a danger of premature induction of labor with inaccurate calculations of the due date. Other concerns addressed in the studies were that certain induction agents are associated with increased risks to the mother and fetus, there is a danger of premature determination that labor has failed to progress in induced labor, and low Bishop scores are associated with a higher risk of cesarean delivery. Conclusions: Patients who electively choose induced labor are giving informed consent for a procedure that requires further studies before it can truly be termed "elective". Further studies that stratify patients by Bishop score are required to determine whether there is a specific range of Bishop score that results in a significantly higher rate of cesarean delivery. It is necessary to perform studies that include a wide variety of participants, such as nulliparous women, so that the results can be more applicable to the general population.

Download or read book Management of Labor and Delivery An Issue of Obstetrics and Gynecology Clinics E Book written by Aaron B. Caughey and published by Elsevier Health Sciences. This book was released on 2017-11-06 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Dr. Caughey has recruited top experts to address the current questions and thinking with regard to the management of labor and delivery. Authors have presented current clinical reviews on the following topics: Defining and managing normal and abnormal first stage of labor; Defining and managing normal and abnormal second stage of labor; Laborist models on labor and delivery; Quality Improvement on Labor and Delivery; Fetal Malposition; Is there a place for outpatient pre-induction cervical ripening; Management of twins on labor and delivery; Cervical ripening techniques: Which is the best; Augmentation of labor: What are the approaches; Elective induction of labor: What is the impact; VBAC trends: Which way is the pendulum swinging; and Update on fetal monitoring. Readers will come away with the current clinical trends and information they need to successfully manage labor and delivery.

Download or read book Maternal and Neonatal Outcomes of Induced Labor in Women with a Prior Cesarean Delivery written by Leigh Christiane Elmore and published by . This book was released on 2000 with total page 114 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Maternal and Fetal Outcomes Associated with Elective Induction of Labor Prior to Thirty nine Weeks Gestation written by Geraldine Hultner and published by . This book was released on 2012 with total page 80 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Recent Declines in Induction of Labor by Gestational Age written by Michelle J. K. Osterman and published by . This book was released on 2014 with total page 10 pages. Available in PDF, EPUB and Kindle. Book excerpt: