C Lindblad Wollmann1,2, M Ahlberg1,2, G Petersson1, S Saltvedt2, O Stephansson1,2. 1. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden. 2. Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska University Hospital and Institutet, Stockholm, Sweden.
Abstract
OBJECTIVE: Determine time-to-delivery and mode-of-delivery in labor induction among women with unripe cervix. STUDY DESIGN: 7551 nulliparous women with singleton deliveries, ⩾37 weeks, Bishop Score ⩽6, induced with dinoprostone, misoprostol or transcervical single balloon catheter. Linear regression analysis was used to estimate mean time-to-delivery with β-estimates and 95% confidence intervals with adjustments. Multivariable logistic regression analysis was used to calculate odds of cesarean delivery, instrumental vaginal delivery, maternal and neonatal outcomes. RESULTS: Adjusted mean time-to-delivery was 6.9 and 1.5 h shorter, respectively, when inducing labor with balloon catheter (mean 18.3 h, β -6.9, 95% confidence intervals; -7.6 to -6.3) or misoprostol (mean 23.7 h, β -1.5, 95% confidence intervals; -2.3 to -0.8) compared with dinoprostone (mean 25.2 h). There were no significant differences in adverse maternal or infant outcomes between induction methods. CONCLUSIONS: Balloon catheter is the most effective induction method with respect to time-to-delivery in nulliparous women at term compared with prostaglandin methods.
OBJECTIVE: Determine time-to-delivery and mode-of-delivery in labor induction among women with unripe cervix. STUDY DESIGN: 7551 nulliparous women with singleton deliveries, ⩾37 weeks, Bishop Score ⩽6, induced with dinoprostone, misoprostol or transcervical single balloon catheter. Linear regression analysis was used to estimate mean time-to-delivery with β-estimates and 95% confidence intervals with adjustments. Multivariable logistic regression analysis was used to calculate odds of cesarean delivery, instrumental vaginal delivery, maternal and neonatal outcomes. RESULTS: Adjusted mean time-to-delivery was 6.9 and 1.5 h shorter, respectively, when inducing labor with balloon catheter (mean 18.3 h, β -6.9, 95% confidence intervals; -7.6 to -6.3) or misoprostol (mean 23.7 h, β -1.5, 95% confidence intervals; -2.3 to -0.8) compared with dinoprostone (mean 25.2 h). There were no significant differences in adverse maternal or infant outcomes between induction methods. CONCLUSIONS: Balloon catheter is the most effective induction method with respect to time-to-delivery in nulliparous women at term compared with prostaglandin methods.
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