INDUCTION OF LABOUR

2013

STATISTICS
WHO recommendations for induction of labour, WHO 2011:
In developed countries, IOL at term: 1 in 4 deliveries. WHO Global Survey on Maternal and Perinatal Health: IOL rate 9.6% of all deliveries. (373 health-care facilities in 24 countries and nearly 300 000 deliveries) Facilities in African countries had lower rates of induction of labour (lowest: Niger, 1.4%) compared with Asian and Latin American countries (highest: Sri Lanka, 35.5%).

460 370 BC. Hippocrates:

Nipple stimulation Hippocratic succussion

130 AD. Soranus of Ephesus: wrote about preterm delivery in women with small pelves
Enema with oil mixed with water and honey Artificial rupture of membranes Midwife to dilate repeatedly the cervix with index finger

936-1013. Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi (Albucasis):

Continues to use digital dilatation Devises instruments to produce dilatation

1510-1590. Ambroise Par:

Instruments to dilate the cervix On mans generation, and how to extract children out of their mothers womb. Wechel, Paris 1573

 1756, London convention:

Induce labour by preterm AROM in women with small pelves

1855. A sponge tent was invented: would enlarge once inserted in cervix and dilate it

1891. Pinard: 100 cases of preterm IOL by

Sponges Enemas AROM Venesection (?...)

Around 1900: Bossis dilator

1894. Boissard balloon. Later: Voorhees metreurynter

 Ergot
Oldest mention: 600 BC 17th century: used by German midwives 18th century: description of use by French midwives 19th century: introduced in North America abandoned due to high foetal mortality

 Quinine
Miscarriages observed with usage for fevers 1885. Mullan: 4 grains (260 mg) of quinine induce labour

Pituitary extract
1909. William Blair Bell starts using it to initiate/augment labour 1928. Du Vigneaud and Abel concentrate the pituitary hormone (i.e. oxytocin with vasopressin).

 1949. Du Vigneaud isolates oxytocin from neurohypophysis 1953. He synthesizes oxytocin (first synthesis of a polypeptide hormone ever)

1955. Du Vigneaud is awarded the Nobel prize for chemistry. Oxytocin is used intravenously.

Prostaglandins
1930 . Raphael Kurzoak & Charles C. Lieb:
Fresh semen applied to strips of myometrium from hysterectomy specimens made the muscle contract or sometimes relax

Later, Goldblatt & von Euler:

Extracts from seminal vesicles and prostate glands were causing contractions or relaxations in smooth muscles of various organs

1969. Chemists at Upjohn Pharmaceuticals & Elias J. Corey and coll. at Harvard:
Synthesize prostaglandins Start the era of the use of prostaglandins in labour induction

Pharmacologic methods
Mozurkewich E L, Chilimigras J L, Berman D R, Perni U C, Romero V C, King V J and Keeton K L Methods of induction of labour: a systematic review BMC Pregnancy Childbirth. 2011; 11: 84. (Univ. Michigan, Ann Arbor)

Intravaginal prostaglandins (PGE2 and PGF2a) Cervical PGE2 Oxytocin Amniotomy Oxytocin with amniotomy Vaginal Misoprostol Oral Misoprostol Buccal or sublingual misoprostol

Mechanical methods
Laminaria tents Dilapan Foley catheters and other types of balloon catheter Membrane sweeping

Complementary and Alternative Medicine Methods

Castor Oil Acupuncture Breast Stimulation Intercourse Homeopathic methods Hypnotic Relaxation

Investigational Methods
Extra-amniotic prostaglandins Intravenous prostaglandins Oral prostaglandins (excluding misoprostol) Mifepristone Oestrogens Corticosteroids Relaxin Hyaluronidase Isosorbide Mononitrate

Breast stimulation
Systematic review (6 studies, 719 subjects): BS vs placebo
No difference in CS rates , uterine hyperactivity RR of not being in labour within 72 hrs: 0,67 (95% CI 0,6-0,74) Less post-partum haemorrhage (!) RR=0.16 (95% CI 0.03-0.87)

Two studies (99 subjects): BS vs Oxytocin

No difference in uterine hyperactivity Fewer women in labour within 72 hrs with BS (nonsignificant)

Mechanical methods for induction of labour.

Cochrane Database Syst Rev. 2012 Mar 14.Jozwiak M, Bloemenkamp KW, Kelly AJ, Mol BW, Irion O, Boulvain M. GroeneHartHospital,Gouda,Netherlands

71 randomised controlled trials (total of 9722 women) - Similar caesarean section rates as prostaglandins, for a lower risk of hyperstimulation. - Same number of women not delivered within 24 hours - However, more multiparas did not achieve vaginal delivery within 24 hours, when compared with vaginal PGE2. - Compared with oxytocin, mechanical methods reduce the risk of caesarean section.

Dilapan

Nitric oxide donors for cervical ripening and induction of labour.

Cochrane Database Syst Rev. 2011 Jun. 15 Kelly AJ, Munson C, Minden L. Royal Sussex County Hospital, Brighton

10 trials (including a total of 1889 women)

- Compared NO donors to placebo, vaginal prostaglandin E2, intracervical PGE2 and vaginal misoprostol - There is no difference between any of the prespecified outcomes, with the exception of an increase in maternal side effects.

Mifepristone for induction of labour

Cochrane Database Syst Rev. 2009 Jul 8. Hapangama D, Neilson JP Perinatal and Reproductive Medicine, The University of Liverpool

Ten trials (1108 women)

Compared to placebo: - More likely to be in labour or to have a favourable cervix at 48 hours (RR 2.41, 95% CI 1.70 to 3.42); effect persisted at 96 hrs. - Less likely to need augmentation with oxytocin (RR 0.80, 95% CI 0.66 to 0.97). - Less likely to undergo caesarean section (RR 0.74, 95% CI 0.60 to 0.92) but more likely to have an instrumental delivery (RR 1.43, 95% CI 1.04 to 1.96). - Less likely to undergo a caesarean section from failure to induce labour (RR 0.40, 95% CI 0.20 to 0.80) - Abnormal FHR patterns more common (RR1.85, 95% CI1.17 to 2.93) but no difference in neonatal outcome

Methods of term labour induction for women with a previous caesarean section
Cochrane Database Syst Rev. 2013 Mar 28 Jozwiak M, Dodd JM LUMC, Leiden, Netherlands

Two studies (involving a total of 80 women) Used different methods and thus, meta-analysis was not appropriate
2.5 mg vaginal PGE2 inserts vs oxytocin (Taylor and coll). No signif. difference in: caesarean section, instrumental vaginal deliveries, epidural analgesia, Apgar score, perinatal death One uterine rupture in the PG group (after oxytocin) Misoprostol vs oxytocin (Wing and coll): 2 uterine ruptures in Misoprostol group Insufficient information