Predictors of mode of birth and duration of labour following induction using prostaglandin vaginal gel

Beckmann, Michael, Gibbons, Kristen, Flenady, Vicki and Kumar, Sailesh (2017) Predictors of mode of birth and duration of labour following induction using prostaglandin vaginal gel. Australian and New Zealand Journal of Obstetrics and Gynaecology, 57 2: 168-175. doi:10.1111/ajo.12588


Author Beckmann, Michael
Gibbons, Kristen
Flenady, Vicki
Kumar, Sailesh
Title Predictors of mode of birth and duration of labour following induction using prostaglandin vaginal gel
Journal name Australian and New Zealand Journal of Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 1479-828X
0004-8666
Publication date 2017-03-13
Year available 2017
Sub-type Article (original research)
DOI 10.1111/ajo.12588
Open Access Status Not yet assessed
Volume 57
Issue 2
Start page 168
End page 175
Total pages 8
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Language eng
Subject 2729 Obstetrics and Gynaecology
Abstract Background and aims: Using data from a randomised controlled trial (RCT) comparing two policies of prostaglandin (PGE2) vaginal gel induction of labour (IOL) at term, this study aimed to determine: (i) demographic/clinical factors that predict IOL outcomes; and (ii) clinical characteristic(s) of women who would benefit from a policy of amniotomy once technically possible as opposed to giving more PGE2. Material and methods: Following an initial PGE2 dose, women were randomised to amniotomy or repeat-PGE2. Using RCT data, two multivariate models were developed, assessing the relationship between demographic/clinical characteristics and the outcomes of caesarean section (CS), and vaginal delivery within 24 h (VD < 24 h). Regression-equations were used to predict the likelihood of CS and VD < 24 h, varying independent predictors from the multivariate analyses. Results: Of 245 term women undergoing IOL, 90 had a CS, 155 delivered vaginally and 79 had a VD < 24 h. Controlling for confounders, nulliparity [adjusted odds ratio (aOR) = 3.71 (1.55, 8.88)] and modified Bishop's score (MBS) at first review [aOR = 0.78 (0.66, 0.92)] were independently associated with CS. Nulliparity [aOR = 0.06 (0.02, 0.15)], MBS at first review [aOR = 1.66 (1.35, 2.05)], and a policy of early amniotomy [aOR = 2.28 (1.04, 5.00)] were associated with VD < 24 h. Modelling using regression equations, and varying both MBS at first review and parity, there was no scenario where repeat PGE2 was predicted to be superior to an earlier amniotomy. Conclusions: Following IOL using PGE2 vaginal gel at term, both parity and cervical favourability at first review are associated with CS and VD < 24 h. All combinations of parity and MBS at first review predicted fewer CS and greater likelihood of VD < 24 h with a policy of amniotomy once technically possible.
Formatted abstract
Background and aims: Using data from a randomised controlled trial (RCT) comparing two policies of prostaglandin (PGE2) vaginal gel induction of labour (IOL) at term, this study aimed to determine: (i) demographic/clinical factors that predict IOL outcomes; and (ii) clinical characteristic(s) of women who would benefit from a policy of amniotomy once technically possible as opposed to giving more PGE2.

Material and methods: Following an initial PGE2 dose, women were randomised to amniotomy or repeat-PGE2. Using RCT data, two multivariate models were developed, assessing the relationship between demographic/clinical characteristics and the outcomes of caesarean section (CS), and vaginal delivery within 24 h (VD < 24 h). Regression-equations were used to predict the likelihood of CS and VD < 24 h, varying independent predictors from the multivariate analyses.

Results: Of 245 term women undergoing IOL, 90 had a CS, 155 delivered vaginally and 79 had a VD < 24 h. Controlling for confounders, nulliparity (adjusted odds ratio (aOR) = 3.71 (1.55, 8.88)) and modified Bishop's score (MBS) at first review (aOR = 0.78 (0.66, 0.92)) were independently associated with CS. Nulliparity (aOR = 0.06 (0.02, 0.15)), MBS at first review (aOR = 1.66 (1.35, 2.05)), and a policy of early amniotomy (aOR = 2.28 (1.04, 5.00)) were associated with VD < 24 h. Modelling using regression equations, and varying both MBS at first review and parity, there was no scenario where repeat PGE2 was predicted to be superior to an earlier amniotomy.

Conclusions: Following IOL using PGE2 vaginal gel at term, both parity and cervical favourability at first review are associated with CS and VD < 24 h. All combinations of parity and MBS at first review predicted fewer CS and greater likelihood of VD < 24 h with a policy of amniotomy once technically possible.
Keyword Cervical ripening
Dinoprostone
Induced
Labour
Regression analysis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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