Association between Maternal Serum Hormones along the Maternal–Fetal Hypothalamic–Pituitary–Adrenal Axis and Successful Vaginal Delivery Measured Prior to Labor Induction

2020 ◽  
Vol 37 (12) ◽  
pp. 1195-1200
Author(s):  
Chase R. Cawyer ◽  
Elena Lobashevksy ◽  
Glenda Corley-Topham ◽  
Sarah Anderson ◽  
John Owen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Hpa Axis ◽  
Maternal Serum ◽  
Labor Induction ◽  
Vaginal Birth ◽  
Serum Hormones ◽  
Hypothalamic Pituitary Adrenal ◽  
Nulliparous Women

Abstract Objective This study aimed to evaluate if maternal serum hormones along the maternal–fetal hypothalamic–pituitary–adrenal (HPA) axis, when drawn prior to labor induction, differed between women who delivered vaginally and those who underwent cesarean. Study Design This was a prospective observational study at a single perinatal center performed from August 2017 to May 2018. Nulliparous women with uncomplicated singleton pregnancies ≥39 weeks had maternal serum collected prior to induction. Corticotrophin-releasing hormone (CRH) was measured by ELISA; dehydroepiandrosterone sulfate (DHEA-S), cortisol, estriol (E3) estradiol (E2), and progesterone (P4) were measured by chemiluminescent reaction. Mean analyte concentrations as well as three ratios (E2/P4, E3/P4, and E2/E3) were compared between women who had a vaginal versus cesarean delivery. Logistic regression was used to model the relationship between CRH and the odds of vaginal birth. We estimated that a sample size of 66 would have 90% power to detect a 25% difference in mean CRH levels assuming a vaginal:cesarean ratio of 2:1 with a baseline CRH concentration of 140 (standard deviation = 36) pg/mL. Results Of the 88 women who had their serum analyzed, 27 (31%) underwent cesarean. Mean maternal serum CRH levels were similar between the vaginal delivery and cesarean groups (122.6 ± 95.2 vs. 112.3 ± 142.4, p = 0.73). Similarly, there were no significant differences in any other maternal serum analytes or ratios. Logistic regression showed a nonsignificant odds ratio for successful vaginal birth (p = 0.69) even when evaluating only the 16 women who had a cesarean for an arrest disorder (p = 0.08). Conclusion In low-risk nulliparous women undergoing full-term labor induction, there were no differences noted in a broad array of other maternal-fetal HPA-axis hormones between women who had a vaginal or cesarean delivery.

Cesarean delivery among women with prolonged labor induction

2016 ◽  
Vol 44 (7) ◽  
Author(s):  
Louise L. Highley ◽  
Rebecca A. Previs ◽  
Sarah K. Dotters-Katz ◽  
Leo R. Brancazio ◽  
Chad A. Grotegut
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Mode Of Delivery ◽  
Labor Induction ◽  
University Hospital ◽  
Delivery Rate ◽  
Multivariate Logistic Regression Model ◽  
Nulliparous Women ◽  
Prolonged Labor ◽  
Cesarean Delivery Rate

AbstractObjective:The objective of this study was to determine characteristics associated with cesarean delivery among women with labor induction lasting over 24 h.Study design:Women with live singleton pregnancies without prior cesarean delivery undergoing a labor induction lasting >24 h between September 2006 and March 2009 at Duke University Hospital were identified. Collected variables were compared between subjects by mode of delivery. A multivariate logistic regression model for the outcome cesarean delivery was constructed separately for nulliparous and parous women.Results:There were 303 women who met inclusion criteria. The overall cesarean delivery rate was 57% (n=172) and remained constant with time (P=0.15, test-for-trend). Nulliparous women having a cesarean delivery were more likely to be obese [adjusted OR (aOR) 2.00; 95% CI 1.05, 3.80] and have a larger fetus [aOR 1.11 (aOR for every 100 g increase in birthweight), 95% CI 1.03, 1.20] compared to those having a vaginal delivery.Conclusion:Increasing BMI and birthweight were independent predictors of cesarean delivery among nulliparous women with prolonged labor induction. Despite this, after 24 h of labor induction, the overall mean cesarean delivery rate remained constant at 57%, and did not change with time. Among women having a vaginal delivery following a prolonged labor induction, we saw high rates of shoulder dystocia, operative vaginal delivery and severe perineal laceration.

Term Labor Induction and Cesarean Delivery Risk among Obese Women with and without Comorbidities

2020 ◽  
Author(s):  
Kimberly B. Glazer ◽  
Valery A. Danilack ◽  
Alison E. Field ◽  
Erika F. Werner ◽  
David A. Savitz
Keyword(s):  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Maternal Age ◽  
Expectant Management ◽  
Labor Induction ◽  
Induction Of Labor ◽  
Low Risk ◽  
Obese Women ◽  
Adjusted Risk ◽  
Nulliparous Women

Objective Findings of the recent ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, showing reduced cesarean risk with elective labor induction among low-risk nulliparous women at 39 weeks' gestation, have the potential to change interventional delivery practices but require examination in wider populations. The aim of this study was to identify whether term induction of labor was associated with reduced cesarean delivery risk among women with obesity, evaluating several maternal characteristics associated with obesity, induction, and cesarean risk. Study Design We studied administrative records for 66,280 singleton, term births to women with a body mass index ≥30, without a prior cesarean delivery, in New York City from 2008 to 2013. We examined elective inductions in 39 and 40 weeks' gestation and calculated adjusted risk ratios for cesarean delivery risk, stratified by parity and maternal age. We additionally evaluated medically indicated inductions at 37 to 40 weeks among women with obesity and diabetic or hypertensive disorders, comorbidities that are strongly associated with obesity. Results Elective induction of labor was associated with a 25% (95% confidence interval: 19–30%) lower adjusted risk of cesarean delivery as compared with expectant management at 39 weeks of gestation and no change in risk at 40 weeks. Patterns were similar when stratified by parity and maternal age. Risk reductions in week 39 were largest among women with a prior vaginal delivery. Women with comorbidities had reduced cesarean risk with early term induction and in 39 weeks. Conclusion Labor induction at 39 weeks was consistently associated with reduced risk of cesarean delivery among women with obesity regardless of parity, age, or comorbidity status. Cesarean delivery findings from induction trials at 39 weeks among low-risk nulliparous women may generalize more broadly across the U.S. obstetric population, with potentially larger benefit among women with a prior vaginal delivery. Key Points

scholarly journals Sonographic Cervical Shortening after Labor Induction is a Predictor of Vaginal Delivery

2016 ◽  
Vol 38 (12) ◽  
pp. 585-588 ◽  
Author(s):  
Ugo Indraccolo ◽  
Gennaro Scutiero ◽  
Pantaleo Greco
Keyword(s):  
Logistic Regression ◽  
Vaginal Delivery ◽  
Regression Models ◽  
Operating Characteristic ◽  
Roc Curves ◽  
Cervical Length ◽  
Labor Induction ◽  
Logistic Regression Models ◽  
Independent Variables ◽  
Sonographic Evaluation

Objective Analyzing if the sonographic evaluation of the cervix (cervical shortening) is a prognostic marker for vaginal delivery. Methods Women who underwent labor induction by using dinoprostone were enrolled. Before the induction and three hours after it, the cervical length was measured by ultrasonography to obtain the cervical shortening. The cervical shortening was introduced in logistic regression models among independent variables and for calculating receiver operating characteristic (ROC) curves. Results Each centimeter in the cervical shortening increases the odds of vaginal delivery in 24.4% within 6 hours; in 16.1% within 24 hours; and in 10.5% within 48 hours. The best predictions for vaginal delivery are achieved for births within 6 and 24 hours, while the cervical shortening poorly predicts vaginal delivery within 48 hours. Conclusion The greater the cervical shortening 3 hours after labor induction, the higher the likelihood of vaginal delivery within 6, 24 and 48 hours.

scholarly journals Clinical predictive factors for vaginal delivery following induction of labour among pregnant women in Jordan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rawan A. Obeidat ◽  
Mahmoud Almaaitah ◽  
Abeer Ben-Sadon ◽  
Dina Istaiti ◽  
Hasan Rawashdeh ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Induction Of Labour ◽  
Labour Induction ◽  
Bishop Score ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
The Mean

Abstract Background Induction of labour (IOL) is an important and common clinical procedure in obstetrics. In the current study, we evaluate predictors of vaginal delivery in both nulliparous and multiparous women in north Jordan who were induced with vaginal prostaglandins. Method A prospective study was conducted on 530 pregnant women at King Abdullah University Hospital (KAUH) in north Jordan. All pregnant mothers with singleton live fetuses, who had induction of labour (IOL) between July 2017 and June 2019, were included in the study. Mode of delivery, whether vaginal or caesarean, was the primary outcome. Several maternal and fetal variables were investigated. The safety and benefit of repeated dosage of vaginal prostaglandin E2 (PGE2) tablets, neonatal outcomes and factors that affect duration of labour were also evaluated. Pearson χ2 test was used to investigate the significance of association between categorical variables, while student’s t-test and ANOVA were applied to examine the mean differences between categorical and numerical variables. Linear regression analysis was utilized to study the relation between two continuous variables. A multivariate regression analysis was then performed. Significance level was considered at alpha less than 0.05. Results Nulliparous women (N = 254) had significantly higher cesarean delivery rate (58.7% vs. 17.8%, p < 0.001) and longer duration of labour (16.1 ± 0.74 h vs. 11.0 ± 0.43 h, p < 0.001) than multiparous women (N = 276). In nulliparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop score; the mean Bishop score was 3.47 ± 0.12 in nulliparous women who had vaginal delivery vs. 3.06 ± 0.10 in women who had cesarean delivery (Adjusted odds ratio (AOR) = 1.2, 95% CI: 1.03–1.28, p = 0.03). In multiparous women, the rate of vaginal delivery was significantly higher in women with higher Bishop scores and lower in women with higher body mass index (BMI). The mean Bishop score was 3.97 ± 0.07 in multiparous women who had vaginal delivery vs. 3.56 ± 0.16 in women who had cesarean delivery (AOR = 1.5, 95% CI: 1.1–2.1, p = 0.01). The mean BMI was 30.24 ± 0.28 kg/m2 in multiparous women who had vaginal delivery vs. 32.36 ± 0.73 kg/m2 in women who had cesarean delivery (AOR = 0.89, 95% CI: 0.84–0.96, p = 0.005). 27% of nulliparous women who received more than two PGE2 tablets and 50% of multiparous women who received more than two PGE2 tablets had vaginal delivery with no significant increase in neonatal morbidity. Conclusion Parity and cervical status are the main predictors of successful labour induction. Further studies are required to investigate the benefit of the use of additional doses of vaginal PGE2 above the recommended dose for IOL.

scholarly journals Development and validation of models to predict cesarean delivery among low-risk nulliparous women at term: a retrospective study in China

2020 ◽  
Author(s):  
Fangcan Sun ◽  
Bing Han ◽  
Fangfang Wu ◽  
Qianqian Shen ◽  
Minhong Shen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cesarean Delivery ◽  
Prediction Models ◽  
External Validation ◽  
Curve Analysis ◽  
Low Risk ◽  
Calibration Plot ◽  
Fetal Sex ◽  
Decision Curve Analysis ◽  
Nulliparous Women

Abstract Background A prediction algorithm to identify women with high risk of an emergency cesarean could help reduce morbidity and mortality associated with labor. The objective of the present study was to derive and validate a simple model to predict intrapartum cesarean delivery for low-risk nulliparous women in Chinese population.Methods We conducted a retrospective cohort study of low-risk nulliparous women with singleton, term, cephalic pregnancies. A predictive model for cesarean delivery was derived using univariate and multivariable logistic regression from the hospital of the First Affiliated Hospital of Soochow University. External validation of the prediction model was then performed using the data from Sihong county People’s Hospital. A new nomogram was established based on the development cohort to predict the cesarean. The ROC curve, calibration plot and decision curve analysis were used to assess the predictive performance.Results The intrapartum cesarean delivery rates in the development cohort and the external validation cohort were 8.79% (576/6,551) and 7.82% (599/7,657). Multivariable logistic regression analysis showed that maternal age, height, BMI, weight gained during pregnancy, gestational age, induction method, meconium-stained amniotic fluid and neonatal sex were independent factors affecting cesarean outcome. We had established two prediction models according to fetal sex was involved or not. The AUC was 0.782 and 0.774, respectively. The two prediction models were well-calibrated with Hosmer-Lemeshow test P=0.263 and P=0.817, respectively. Decision curve analysis demonstrated that two models had clinical application value, and they provided greatest net benefit between threshold probabilities of 4% to 60%. And internal validation using Bootstrap method demonstrated similar discriminatory ability. We external validated the model involving fetal sex, for which the AUC was 0.775, while the slope and intercept of the calibration plot were 0.979 and 0.004, respectively. On the external validation set, another model had an AUC of 0.775 and a calibration slope of 1.007. The online web server was constructed based on the nomogram for convenient clinical use.Conclusions Both two models established by these factors have good prediction efficiency and high accuracy, which can provide the reference for clinicians to guide pregnant women to choose an appropriate delivery mode.

Development And Validation Of Models To Predict Cesarean Delivery Among Low-Risk Nulliparous Women At Term: A Retrospective Study In China

2020 ◽  
Author(s):  
Fangcan Sun ◽  
Bing Han ◽  
Fangfang Wu ◽  
Qianqian Shen ◽  
Minhong Shen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Cesarean Delivery ◽  
Prediction Models ◽  
External Validation ◽  
Curve Analysis ◽  
Low Risk ◽  
Multivariable Logistic Regression Analysis ◽  
Decision Curve Analysis ◽  
Nulliparous Women

Abstract Background: Cesarean delivery after failure of trial of labor is associated with adverse maternal and perinatal outcomes. A prediction algorithm to identify women with high risk of an emergency cesarean could help reduce morbidity and mortality associated with labor. The objective of the present study was to derive and validate a simple model to predict cesarean delivery for low-risk nulliparous women in Chinese population.Methods: This retrospective study analyzed the low-risk nulliparous women with singleton cephalic full-term fetus delivered in two medical centers. After the clinical data of the women who delivered at the tertiary referral center (n=6 551) was collected and was used univariate and multivariable logistic regression analysis, the prediction model was fitted. We performed external validation using data from nulliparous who delivered from another hospital(secondary referral center, n=7 657). A new nomogram was established based on the development cohort to predict the cesarean. The ROC curve, calibration plot and decision curve analysis were used to assess the predictive performance. Results: The cesarean delivery rates in the development cohort and the external validation cohort were 8.79% (576/6 551) and 7.82% (599/7 657). Multivariable logistic regression analysis showed that maternal age, height, BMI, weight gained during pregnancy, gestational age, induction method, meconium-stained amniotic fluid and neonatal sex were independent factors affecting cesarean outcome. Because sex of the fetuses were unknown until they born(China's Fertility Policy), we established two prediction models according to fetal sex was involved or not. The AUC was 0.782 and 0.774, respectively. The Hosmer-Lemeshow goodness-of-fit test showed that these two models fitted well. Decision curve analysis demonstrated that the models were clinically useful. And internal validation using Bootstrap method showed that these prediction models perform well. On the external validation set, the AUC were 0.775 and 0.775, respectively. The calibration plots for the probability of cesarean showed a good correlation. The online web server was constructed based on the nomogram for convenient clinical use.Conclusions: Both two models established by these factors have good prediction efficiency and high accuracy, which can provide the reference for clinicians to guide pregnant women to choose an appropriate delivery mode.

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