Induction of Labour: Change of Method and its Effects

Abstract

Aim: The combination of mechanical and drug procedures for the induction of labour seems to be beneficial. Accordingly, the normal procedure in clinical routine has been changed and induction of labour by means of a balloon catheter has been implemented. The aim of this study was to find out if this procedural change has resulted in a more effective induction of labour. Materials and Method: In this historical cohort study 230 inductions of labour at term in the year 2012 were compared with 291 inductions of labour in the year 2013, all at the University of Erlangen Perinatal Centre. Exclusion criteria were, among others, a multiple pregnancy, a premature rupture of membranes and a prior Caesarean section. In 2012 births were induced solely by use of the drugs dinoprostone and misoprostol, in 2013 not only with misoprostol but also mainly by use of a balloon catheter. The primary target parameter was the rate of failed labour inductions, defined as “no birth within 72 hours”. Results: Altogether 521 inductions of labour were analysed. The rate of failed inductions of labour could be reduced by the changes in induction method (first-time mothers: 23 vs. 9 %, p = 0.0059; multiparous women: 10 vs. 1 %, p = 0.0204). Furthermore, the rate of primary Caesarean sections due to failed induction of labour (5.7 vs. 1.4 %, p = 0.0064), that of the observation of green amniotic fluid (first-time mothers: 23 vs. 9 %, p = 0.0059; multiparous women: 10 vs. 1 %, p = 0.0204) and of infantile infections (first-time mothers: 23 vs. 9 %, p = 0.0059; multiparous women: 10 vs. 1 %, p = 0.0204) were all reduced as well. Conclusion: The routine use of a balloon catheter for induction of labour has markedly improved the procedure. There were fewer failed labour inductions and fewer Caesarean sections due to failed induction of labour.

Zusammenfassung

Ziel: Die Kombination mechanischer und medikamentöser Verfahren zur Geburtseinleitung scheint vorteilhaft zu sein. Daher wurde das routinemäßige Vorgehen im klinischen Alltag geändert und die Geburtseinleitung mit Ballonkathetern implementiert. Ziel dieser Studie war es herauszufinden, ob diese Änderung zu einer effektiveren Geburtseinleitung geführt hat. Material und Methode: In dieser historischen Kohortenstudie wurden 230 Geburtseinleitungen am Termin des Jahres 2012 mit 291 Geburtseinleitungen aus dem Jahr 2013, die am Universitäts-Perinatalzentrum Erlangen durchgeführt wurden, verglichen. Ausschlusskriterien waren u. a. eine Mehrlingsschwangerschaft, ein vorzeitiger Blasensprung und ein vorheriger Kaiserschnitt. Im Jahr 2012 wurden Geburten ausschließlich medikamentös mit Dinoproston und Misoprostol eingeleitet, 2013 neben Misoprostol vorwiegend mit Ballonkathetern. Der primäre Zielparameter war die Rate an frustranen Geburtseinleitungen, definiert als „keine Geburt innerhalb 72 Stunden“. Ergebnis: Insgesamt wurden 521 Geburtseinleitungen analysiert. Die Rate an frustranen Geburtseinleitungen konnte durch die Umstellung des Einleitungsregimes verringert werden (Erstgebärende: 23 vs. 9 %, p = 0,0059; Mehrgebärende: 10 vs. 1 %, p = 0,0204). Reduziert wurden weiterhin die Rate an primären Kaiserschnitten wegen einer frustranen Geburtseinleitung (5,7 vs. 1,4 %, p = 0,0064), das Auftreten von grünem Fruchtwasser (Erstgebärende: 23 vs. 9 %, p = 0,0059; Mehrgebärende: 10 vs. 1 %, p = 0,0204) und von kindlichen Infektionen (Erstgebärende: 23 vs. 9 %, p = 0,0059; Mehrgebärende: 10 vs. 1 %, p = 0,0204). Schlussfolgerung: Die routinemäßige Verwendung von Ballonkathetern zur Geburtseinleitung verbesserte die Geburtseinleitung. Es kam zu weniger frustranen Geburtseinleitungen und zu weniger Kaiserschnitten wegen einer frustranen Geburtseinleitung.

Key words

induction of labour - balloon catheter - misoprostol - efficacy - dinoprostone - method

Schlüsselwörter

Geburtseinleitung - Ballonkatheter - Misoprostol - Effektivität - Dinoproston - Regime

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