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Maternal And Fetal Outcomes Associated With Elective Induction Of Labor Prior To Thirty Nine Weeks Gestation
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Book Synopsis Maternal and Fetal Outcomes Associated with Elective Induction of Labor Prior to Thirty-nine Weeks Gestation by : Geraldine Hultner
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:
Book Synopsis Maternal and Neonatal Outcomes of Elective Induction of Labor by :
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.
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :0309669820 Total Pages :369 pages Book Rating :4.3/5 (96 download)
Book Synopsis Birth Settings in America by : National Academies of Sciences, Engineering, and Medicine
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.
Book Synopsis Elective Induction of Labor and Associated Adverse Outcomes to Mother and Baby by : Michele Jakowinicz
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.
Book Synopsis WHO recommendations on induction of labour, at or beyond term by : World Health Organization
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.
Book Synopsis Reducing Elective Inductions of Labor by : Ashley Aronhalt
Download or read book Reducing Elective Inductions of Labor written by Ashley Aronhalt and published by . This book was released on 2014 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Elective inductions have been common practice over the past twenty years with no regard to the effects and negative outcomes associated to both mother and fetus/newborn, until recently. Several organizations are supporting the current research to reduce elective inductions of labor and to influence spontaneous labor for the benefits to both mother and fetus/neonate through increased attendance at prepared childbirth classes. Several organizations also support elective inductions of labor if the gestational age is greater than thirty-nine weeks, which with evidence based practices showing the greatest benefits of greater than forty weeks gestation. Discussed in this paper are the risks and complications associated with an elective induction of labor and the reasons behind why women and Obstetricians schedule elective inductions of labor with no medical indication. The end-goal is to establish a Nation-wide policy to set elective inductions of labor to no earlier than forty weeks documented gestational age with education provided to women who are pregnant on risks and complications associated with elective inductions of labor. The proposed change is discussed thoroughly as well as the process and chain of approvals established before the change can be set into a hospital policy with key stakeholders identified. Women who are educated can make better informed decisions on their care. Discussed is the implementation plan and evaluation process through staff surveys, patient surveys, sample checklists, consent forms, and a Power Point presentation with vital information on the importance of creating change to improve the quality of life of newborns and mothers. Dissemination of the data collected to stakeholders and the greater nursing community is discussed at the end. The push for the past ten years has been to encourage physicians to question traditional/common practices and to base clinical decisions off of evidence-based practice.
Author :U. S. Department of Health and Human Services Publisher :Createspace Independent Pub ISBN 13 :9781490324241 Total Pages :262 pages Book Rating :4.3/5 (242 download)
Book Synopsis Maternal and Neonatal Outcomes of Elective Induction of Labor by : U. S. Department of Health and Human Services
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 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.
Book Synopsis Adverse Maternal and Neonatal Delivery Outcomes Associated with Non-indicated Labor Induction at 39 Weeks Gestation by : Noa A. Kay
Download or read book Adverse Maternal and Neonatal Delivery Outcomes Associated with Non-indicated Labor Induction at 39 Weeks Gestation written by Noa A. Kay and published by . This book was released on 2011 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Professional Research Project by : Dana Pride
Download or read book Professional Research Project written by Dana Pride 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 studies, cesarean deliveries have reached an all-time high while have also providers choosing to electively induce labor in pregnant mothers prior to 39 weeks gestations and prior to cervical preparedness. Due to the growing concerns related to failed induction of labors, increased rates of cesarean deliveries, maternal and neonatal complications leading to extended hospital stays and increasing cost to both the patient and hospital, reputable healthcare associations conducted research across the nation. It was identified patients induced prior to either 39 weeks or cervical preparedness, defined as a mother with a Bishop Score less than 8 have a two-fold increased risk of cesarean delivery post an early elective induction. Major stakeholders in evidence based research have identified variables causative of this problem and have developed toolkits pertaining to early elective delivery and cervical ripening, which include policy and protocol recommendations, education materials and evaluation tools. With standardization of education and clinical practices guidelines to support elimination of deliveries prior to 39 weeks and utilization pharmaceutical methods to ripen the cervix when the Bishop score is less than 8, have proven to be effective in reducing the number of mothers scheduled to electively delivery and those mothers who are induced increasing the utilization of cervical ripeners improving patients expected outcomes which would be the conclusion of a vaginal delivery. By implementing these practice guidelines, there is the potential to decrease cesarean delivery rates, improve outcomes for both mother and baby and decrease associated costs.
Book Synopsis Evidence-based Maternity Care by : Carol Sakala
Download or read book Evidence-based Maternity Care written by Carol Sakala and published by . This book was released on 2008 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Evidence-based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns."-- From foreword.
Book Synopsis Recent Declines in Induction of Labor by Gestational Age by : Michelle J. K. Osterman
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:
Book Synopsis Disease Control Priorities, Third Edition (Volume 2) by : Robert Black
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.
Book Synopsis WHO Recommendations on Intrapartum Care for a Positive Childbirth Experience by : World Health Organization
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.
Book Synopsis WHO Recommendations for Augmentation of Labour by : World Health Organization
Download or read book WHO Recommendations for Augmentation of Labour written by World Health Organization and published by World Health Organization. This book was released on 2014 with total page 62 pages. Available in PDF, EPUB and Kindle. Book excerpt: Optimizing outcomes for women in labor at the global level requires evidence-based guidance of health workers to improve care through appropriate patient selection and use of effective interventions. In this regard, the World Health Organization (WHO) published recommendations for induction of labor in 2011. The goal of the present guideline is to consolidate the guidance for effective interventions that are needed to reduce the global burden of prolonged labor and its consequences. The primary target audience includes health professionals responsible for developing national and local health protocols and policies, as well as obstetricians, midwives, nurses, general medical practitioners, managers of maternal and child health programs, and public health policy-makers in all settings.
Book Synopsis Optimal Care in Childbirth by : Henci Goer
Download or read book Optimal Care in Childbirth written by Henci Goer and published by . This book was released on 2013-06 with total page 582 pages. Available in PDF, EPUB and Kindle. Book excerpt: Meticulously documented, Optimal Care in Childbirth pulls back the curtain on medical-model management of childbirth. Written for those who want to practice according to the best evidence, assist women in making informed decisions, or advocate for maternity care reforms, it provides an in-depth analysis of the evidence basis for physiologic care.
Book Synopsis Handbook of Clinical Obstetrics by : E. Albert Reece, MD, PhD, MBA
Download or read book Handbook of Clinical Obstetrics written by E. Albert Reece, MD, PhD, MBA and published by John Wiley & Sons. This book was released on 2008-04-15 with total page 600 pages. Available in PDF, EPUB and Kindle. Book excerpt: The second edition of this quick reference handbook for obstetricians and gynecologists and primary care physicians is designed to complement the parent textbook Clinical Obstetrics: The Fetus & Mother The third edition of Clinical Obstetrics: The Fetus & Mother is unique in that it gives in-depth attention to the two patients – fetus and mother, with special coverage of each patient. Clinical Obstetrics thoroughly reviews the biology, pathology, and clinical management of disorders affecting both the fetus and the mother. Clinical Obstetrics: The Fetus & Mother - Handbook provides the practising physician with succinct, clinically focused information in an easily retrievable format that facilitates diagnosis, evaluation, and treatment. When you need fast answers to specific questions, you can turn with confidence to this streamlined, updated reference.
