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Risk Factor For Cesarean
Delivery Following LaborInduction In Multiparous
Women
By: Nurmadiah, Novita AS, Putri P,
Ridwan B, Said TS, Yvonne FY.
Advisor:
Dr. Eddy Pangaribuan, Sp.OG (K)
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INTRODUCTION
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INTRODUCTION
A common and essential element ofcontemporary obstetric practice andnow accounts for approximately 20% ofall deliveries.
Thought to be associated with increasein the risk of cesarean delivery both fornulliparous and multiparous.
Induction of labor
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INTRODUCTION
Cesarean delivery:
The procedure carries theoperative risk in index
pregnancy and future pregnancy
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OBJECTIVES
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OBJECTIVE
To identifypotential riskfactors forcesarean deliveryfollowing labor
induction inmultiparouswomen at term.
Objective
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METHODS
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METHODS
We conducted a retrospectivecase-control study
Department of Obstetric andGynecology of the Maxima MedicalCentre, Veldhoven, The Netherlands,
1995-2010Included: multiparous, singlepregnancy, above 37 weeks
Excluded: fetal anomaly, noncephalicpresentation
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Controls
2 multiparous women withsuccessful induction of labor for
each case
Successful induction of labor
achieving vaginal deliveryanytime after the onset of
induction of labor
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Induction of labor
Patients with unfavorable cervix(Bishop score < 6)
Received 2 mg Prostin gel (1 mg forprelabor rupture of membranes) inposterior fornix of the vagina
Repeating th dose after 6 hours ifnecessary, depending on the Bishopscore
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Induction of labor
Amniotomy was performed inwomen with a favorable cervix
(Bishop score 6)
Oxytocin augmentation wasstarted with unsatisfactoryprogress of labor orcontractions were absent 60minutes after amniotomy
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Cases and controls
Maternal age
Height
Body mass index
Parity
Reason for induction
Gestational age
Bishop score
Need for epidural
Birth weight
Reason for cesarean delivery
Collected data:
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RESULTS
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RESULT
There was no significant difference in maternal age, parity, or reason forinduction of labor between cases and controls
Characteristics of the study population
Cesarean delivery was significantly associated with gestational age atdelivery, BMI, and matenal age
Gestational age at delivery, BMI, maternal age
Did not differ between cases and controls
Amount of effacement of cervix at the start of induction
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Associatedwith the riskof cesarean
delivery:
more dilated atstart of
induction
Nonengagementof the fetal head
Need for usingprostaglandins
as inductionmethod
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Previous obstetric history
Women with only previous preterm deliveryhad a significantly higher risk of cesareandelivery than those with at least oneprevious term delivery
Birth weight
No difference between the two groups
MULTIVARIATE ANALYSIS
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MULTIVARIATE ANALYSIS
The risk of cesarean delivery was
significantly associated with
low maternal height (OR 0.87,95%CI 0.80-0.95, P = 0.002)
A history of preterm delivery (OR5.3, 95% CI 1.1-25, P = 0.042)
Amount of dilatation at the startof induction of labor (OR 0.43,
95% CI 0.19-0.98, P=0.043)
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CESARIAN DELIVERY GROUP
10 women (13%) with presenting fetal head at the level of thepelvic inlet, so at station -3
50% of them, the method of induction was amniotomy, mostlyfollowed by oxytosin
Cesarean delivery group
Failure to progress because of negleted transverse lie (n=3) Prolapsed fetal arm (n=3)
Prolapsed umbilicard cord (n=1)
Non-engaged persistent occiput anterior position (n=1)
Fetal distress (n=2)
Indications for cesarean delivery:
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CONTROL GROUP
7 women (4%) the presenting fetal head at the
start of labor was at station -3
Only 29% of these seven women amniotomy was
performed, and they all delivered spontaneously
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DISCUSSION
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This study demonstrates that maternalheight, the amount of dilatation at thestart of induction and a history ofpreterm delivery played significant
roles in determining the risk ofcesarean delivery in inducedmultiparous women.
Induction of labor in multiparous womenresulted in a cesarean delivery rate of 3%
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In this study, in which we only includedwomen with at least one previous vaginal
birth
We considered the need for a cesarean after inductionof labor in a multiparous woman as the outcome
measure failure of induction of labor. Although awoman might have reached active labor, we were notinterested in another definition of failed induction,such as not reaching vaginal delivery within 24 hours.
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Women with a previous preterm delivery had
a higher risk of cesarean delivery afterinduced labor than those withat least oneprevious term delivery.
Our results are in line with the results of Park,indicating that the course of induction inwomen with a history of preterm deliverydiffers from women with a term delivery.
Preterm delivery
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In 13% (10/80) of the cases, the fetal head at thestart of induction was at station -3, whereas in
the control group this was only 4% (7/160).Taking the reasons for cesarean delivery in thesecases into account, one may conclude that oneshould be careful performing amniotomy if thefetal head is not properly engaged.
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Although we are aware of the additional risks
inducing women with a history of cesareandelivery, we included in both cases andcontrols six women with a previous cesareandelivery, besides a previous vaginal delivery. A
history of previous cesarean delivery was, inour study, not significantly associated with theoccurrence of cesarean delivery after inductionof labor.
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The 3% rate of cesarean delivery in
multiparous women in whom labor wasinduced should be compared with thecesarean delivery rate in multiparouswomen with spontaneous labor. Heffnerreports a cesarean delivery rate of 2.4%among multiparous women withspontaneous labor.
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The study of Jacquemyn et al. reported acesarean delivery rate of 1.5% in womenwith spontaneous onset of labor, ascompared to 2.8% in women withinduced labor . In the study of Nicholson
the cesarean delivery rate was 9.9%
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In multiparous women, the risk ofcesarean delivery following labor
induction increases with previouspreterm delivery, short maternalheight, and limited dilatation at thestart of induction.
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