American Journal of Obstetrics & Gynecology Mfm最新文献

Background: Assessing maternal pain and satisfaction following administration of paracetamol vs. placebo prior to catheter balloon placement.

Methods: Primiparous women at term admitted for medically-indicated labor induction were randomized to receive intravenous paracetamol 1 gram in 100cc normal saline (N=71) or placebo of 100cc normal saline (N=70) prior to catheter balloon insertion. The women were blinded to the intervention allocation. Primary outcomes were visual analog scale (VAS) scores and maternal satisfaction, assessed via questionnaire.

Results: Pre-induction maternal pain did not differ between the paracetamol and placebo groups. Median VAS scores at 2, 30, and 60 minutes after catheter insertion were comparable between the groups: 6.46±2.77 vs. 6.66±2.78, p=0.68; 5.53±3.20 vs. 5.93±3.01, p=0.46; and 5.83±3.25 vs. 6.49±2.88, p=0.26, respectively. For the paracetamol vs. placebo group, the mean sum of VAS scores was lower (4.39 vs. 5.37, p=0.045) and the proportion with a mean VAS score <5 was higher (65.2% vs. 44.1%, p=0.016). This difference persisted in a multivariate logistic regression analysis adjusted for maternal age (OR=2.2, 95% CI 1.1-4.5, p=0.036). After balloon insertion, relatively fewer women in the paracetamol vs. placebo group showed immobility (33.8% vs 50.0%, p=0.037) and needed analgesics (31.3% vs. 66.1%, p<0.001). Maternal satisfaction score was similar between the groups (P=0.877). Cervical ripening, duration from catheter insertion to delivery, and labor and neonatal outcomes did not differ significantly between the groups.

Conclusions: The administration of paracetamol compared with placebo prior to catheter balloon insertion was associated with lower VAS score and less analgesic use and maternal immobility.

Background: As induction of labor increases in the United States, safe, effective outpatient cervical ripening has been explored as a method to decrease the inpatient time burden. The most effective method of outpatient mechanical cervical ripening remains unclear.

Objective: To evaluate if Dilapan-S is non-inferior to cervical balloon for outpatient cervical ripening (CR) based on change in Bishop score.

Study design: This was a single-blind, randomized controlled trial at a single tertiary hospital. Term patients, both nulliparous and multiparous, aged 18-50 with a singleton, cephalic fetus and no prior c-section who were scheduled for outpatient CR per pre-existing hospital policy were eligible. Participants were randomized to single balloon cervical ripening with a Cook catheter with 60mL in the intrauterine balloon or placement of 3 to 5 Dilapan-S hydroscopic dilators and were then discharged home. On return to the hospital, the CR agent was removed, a blinded cervical exam performed, and participants completed a satisfaction survey. Further induction proceeded per their obstetrical provider. The primary outcome was change in Bishop score. Secondary outcomes included patient satisfaction, mode of delivery, induction time, adverse maternal and neonatal outcomes and a cervical ripening failure composite (failure to place randomized cervical ripening agent, prelabor rupture of membranes prior to scheduled return to hospital, significant vaginal bleeding, or need for further cervical ripening after the initial agent is removed) .We had 80% power to show non-inferiority in change in Bishop score with a margin of 2 and standard deviation of 3.

Results: From May 2022 to June 2023, 80 participants were randomized with no difference in baseline demographic data, starting dilation, or Bishop score. 70% of participants in each arm were nulliparous. There was no difference in change in Bishop score between Dilapan-S and cervical balloon (median change 3 (interquartile range (IQR) 2-5) vs 3 (IQR2-4.5) respectively, p=0.91). There was no difference in time to delivery, mode of delivery, or maternal or neonatal outcomes. Participants randomized to Dilapan-S were more satisfied with their experience (satisfaction scale 0-10, median 9 (IQR 8-10) vs 8 (IQR 5-9), p<0.01) and were less likely to experience cervical ripening failure (7(17.5%) vs 18(45%), p<0.01) compared to participants who were randomized to cervical balloon.

Conclusions: Dilapan-S was non-inferior to cervical balloon catheter for outpatient cervical ripening based on change in Bishop score. Participants were more satisfied with Dilapan-S and less likely to experience cervical ripening failure compared to a cervical catheter with single balloon inflation.

Objective: To evaluate the effect of nitroglycerine on placenta delivery after retained placenta DESIGN: Systematic review with meta-analysis DATA SOURCES: MEDLINE, PROSPERO, Scopus, ClinicalTrials.gov, EMBASE, Sciencedirect, the Cochrane Library, Scielo were searched from their inception until February 2024.

Eligibility criteria for selecting studies: We included all randomized clinical trials comparing use of nitroglycerine (i.e. intervention group) with placebo or with no treatment (i.e. control group) given for retained placenta after vaginal delivery.

Data synthesis: The primary outcome was rate of manual removal of the placenta. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% of confidence interval (CI).

Results: Five trials, including 1,362 pregnancies, were analyzed. The quality of the RCTs included was moderate. Pooled results showed that administration of nitroglycerine in women with retained placenta after vaginal delivery was associated with similar incidence of manual removal compared to control (87% vs 89%; RR 0.92, 95% CI 0.75 to 1.13). We also found similar mean postpartum blood loss, and no significant differences in the incidence of drop of hb > 15 or 30%, need for uterotonics.

Conclusions: Use of nitroglycerine in women with retained placenta after vaginal delivery did not reduce the use of manual removal of the placenta.