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419: Induction of labor in an obese population: are we choosing the right method?
Poster Session II
ajog.org
420 Uterine electrical activity, oxytocin & labor translating electrical into mechanical
419 Induction of labor in an obese population: are we choosing the right method? Nandini Raghuraman, Kimberly A. Roehl, Methodius G. Tuuli, Roxane M. Rampersad, George A. Macones, Alison G. Cahill Washington University in St. Louis, Saint Louis, MO
OBJECTIVE: Obese women are at risk for pregnancy complications that require induction of labor. Combination (mechanical and pharmacologic) induction methods with foley balloons (FB) and either oxytocin (OT) or prostaglandins have been proven efficacious, however there is limited data on these combined induction methods in obese women. We investigated the duration and progress of the first stage of labor in obese women undergoing FB induction with either OT or misoprostol. STUDY DESIGN: This was a retrospective study of term, singleton, non-anomalous deliveries at a tertiary care center from 20042014. Obese (BMI30 kg/m2) women who underwent combination inductions and completed the first stage of labor were included in this study. Baseline characteristics and labor intervals were compared in those induced with FB and OT (FB/OT group) versus with FB and misoprostol (FB/misoprostol group). The median duration of latent phase (1-4cm) and active phase (610cm) were compared between groups. Median progression in one centimeter intervals was estimated using interval-censored regression analysis. RESULTS: Of the 992 obese patients who underwent combination inductions, 346 (34.9%) received FB/ OT, while 646 (65.1%) received FB/ misoprostol. Women in the FB/misoprostol group were more likely to be nulliparous (73.7% vs 43.4%, p <0.01) and have a lower admission Bishop score (1.11.0 vs 1.81.3, p<0.01). There was no difference in cesarean rate between both groups (45.1% vs 39.9%, p 0.12). After adjusting for Bishop score and parity, we found that both the latent phase (median hours, [5th percentile, 95th percentile] 7.2, [2.2, 3.2]) and active phase (3.4, [0.6, 19.7]) of labor were significantly longer in the FB/misoprostol group as compared to the FB/OT group. The estimated progression from 1-2cm was significantly longer in the FB/misoprostol group (4.3 [1.1, 16.9]). (Table) CONCLUSION: FB/OT may be a preferable induction method over FB/ misoprostol in obese patients as it is associated with shorter latent and active phases of labor with no increase in cesarean rate.
Anat Lavie, Amir Aviram, Liran Hiersch, Eran Ashwal, Yariv Yogev Lis Maternity and Women’s Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
OBJECTIVE: To determine the impact of oxytocin administration on
uterine electrical activity (UEA) during augmentation of labor, and to assess this tool for prediction of vaginal delivery. STUDY DESIGN: UEA was prospectively measured using electrical uterine myography (EUM) in women undergoing labor augmentation. Oxytocin starting dose was 5mU/min, and was increased every 20 minutes by 5mU/min until 4 contractions per 10 minutes. Eligibility was limited to singleton term (37+0w) pregnancies without uterine scar. The EUM recorded UEA using non-invasive, nine-channel recorder with an electromyography amplifier and a 3D position sensor. Results were reported as the mean electrical activity in ten minutes intervals, measured in units of microwatt per second (EUM index, mW/s). Measurements were performed 30 minutes prior to Oxytocin initiation and until at least 4 contractions per 10 minutes were recorded by standard tocodynamometry. Each woman served as her own control. Delta EUM index was defined as the difference between mean EUM before and after initiation of Oxytocin and was evaluated by paired samples Student’s T test. RESULTS: 1. 81 women were included. Of them, 45 (55.5%) had a rupture of membrane, either spontaneous or induced, before the administration of Oxytocin. 79 (97.5%) women had an epidural analgesia. The average cervical dilatation at enrollment was 3.8+2.3 cm. 62 (76.5%) women delivered vaginally, 16 (19.7%) underwent vacuum extraction and 3 (3.8%) underwent cesarean section. 2. Mean EUM Index under Oxytocin augmentation at 4 contractions per 10 minutes was significantly higher than prior to Oxytocin (3.720.41 s vs. 3.210.56 mW/s, p<0.001), correlation of R¼0.568. 3. This significant increase in mean EUM index was further observed in subgroup analysis of the study cohort according to parity and cervical dilatation at initiation of Oxytocin augmentation (Table 1). 4. Delta EUM index was not found to be significantly affected by maternal age, parity, BMI or cervical dilatation at initiation of augmentation (Table 2).
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S249
ajog.org
420 Uterine electrical activity, oxytocin & labor translating electrical into mechanical
419 Induction of labor in an obese population: are we choosing the right method? Nandini Raghuraman, Kimberly A. Roehl, Methodius G. Tuuli, Roxane M. Rampersad, George A. Macones, Alison G. Cahill Washington University in St. Louis, Saint Louis, MO
OBJECTIVE: Obese women are at risk for pregnancy complications that require induction of labor. Combination (mechanical and pharmacologic) induction methods with foley balloons (FB) and either oxytocin (OT) or prostaglandins have been proven efficacious, however there is limited data on these combined induction methods in obese women. We investigated the duration and progress of the first stage of labor in obese women undergoing FB induction with either OT or misoprostol. STUDY DESIGN: This was a retrospective study of term, singleton, non-anomalous deliveries at a tertiary care center from 20042014. Obese (BMI30 kg/m2) women who underwent combination inductions and completed the first stage of labor were included in this study. Baseline characteristics and labor intervals were compared in those induced with FB and OT (FB/OT group) versus with FB and misoprostol (FB/misoprostol group). The median duration of latent phase (1-4cm) and active phase (610cm) were compared between groups. Median progression in one centimeter intervals was estimated using interval-censored regression analysis. RESULTS: Of the 992 obese patients who underwent combination inductions, 346 (34.9%) received FB/ OT, while 646 (65.1%) received FB/ misoprostol. Women in the FB/misoprostol group were more likely to be nulliparous (73.7% vs 43.4%, p <0.01) and have a lower admission Bishop score (1.11.0 vs 1.81.3, p<0.01). There was no difference in cesarean rate between both groups (45.1% vs 39.9%, p 0.12). After adjusting for Bishop score and parity, we found that both the latent phase (median hours, [5th percentile, 95th percentile] 7.2, [2.2, 3.2]) and active phase (3.4, [0.6, 19.7]) of labor were significantly longer in the FB/misoprostol group as compared to the FB/OT group. The estimated progression from 1-2cm was significantly longer in the FB/misoprostol group (4.3 [1.1, 16.9]). (Table) CONCLUSION: FB/OT may be a preferable induction method over FB/ misoprostol in obese patients as it is associated with shorter latent and active phases of labor with no increase in cesarean rate.
Anat Lavie, Amir Aviram, Liran Hiersch, Eran Ashwal, Yariv Yogev Lis Maternity and Women’s Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
OBJECTIVE: To determine the impact of oxytocin administration on
uterine electrical activity (UEA) during augmentation of labor, and to assess this tool for prediction of vaginal delivery. STUDY DESIGN: UEA was prospectively measured using electrical uterine myography (EUM) in women undergoing labor augmentation. Oxytocin starting dose was 5mU/min, and was increased every 20 minutes by 5mU/min until 4 contractions per 10 minutes. Eligibility was limited to singleton term (37+0w) pregnancies without uterine scar. The EUM recorded UEA using non-invasive, nine-channel recorder with an electromyography amplifier and a 3D position sensor. Results were reported as the mean electrical activity in ten minutes intervals, measured in units of microwatt per second (EUM index, mW/s). Measurements were performed 30 minutes prior to Oxytocin initiation and until at least 4 contractions per 10 minutes were recorded by standard tocodynamometry. Each woman served as her own control. Delta EUM index was defined as the difference between mean EUM before and after initiation of Oxytocin and was evaluated by paired samples Student’s T test. RESULTS: 1. 81 women were included. Of them, 45 (55.5%) had a rupture of membrane, either spontaneous or induced, before the administration of Oxytocin. 79 (97.5%) women had an epidural analgesia. The average cervical dilatation at enrollment was 3.8+2.3 cm. 62 (76.5%) women delivered vaginally, 16 (19.7%) underwent vacuum extraction and 3 (3.8%) underwent cesarean section. 2. Mean EUM Index under Oxytocin augmentation at 4 contractions per 10 minutes was significantly higher than prior to Oxytocin (3.720.41 s vs. 3.210.56 mW/s, p<0.001), correlation of R¼0.568. 3. This significant increase in mean EUM index was further observed in subgroup analysis of the study cohort according to parity and cervical dilatation at initiation of Oxytocin augmentation (Table 1). 4. Delta EUM index was not found to be significantly affected by maternal age, parity, BMI or cervical dilatation at initiation of augmentation (Table 2).
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S249