Search Our Scientific Publications & Authors

J Midwifery Womens Health 2021 May 13. Epub 2021 May 13.

School of Nursing, Vanderbilt University, Nashville, Tennessee.

Induction of labor is increasingly a common component of the intrapartum care. Knowledge of the current evidence on methods of labor induction is an essential component of shared decision-making to determine which induction method meets an individual's health needs and personal preferences. This article provides a review of the current research evidence on labor induction methods, including cervical ripening techniques, and contraction stimulation techniques. Read More

Arch Gynecol Obstet 2021 May 12. Epub 2021 May 12.

Department of Obstetrics and Gynecology, Meir Medical Center, Tchernichovsky 59, 44281, Kfar Saba, Israel.

Purpose: To evaluate the effect of changes in sonographic cervical length (CL) measured at 14-16 and 21-24 weeks of gestation, on cervical ripening in term pregnancies.

Methods: This retrospective, cohort study included term pregnancies with CL measured with transvaginal sonography (CL at 14-16 weeks gestation and CL at 21-24 weeks). History of preterm labor, multiple gestations, planned caesarean section, fetal anomalies and stillbirths were excluded. Read More

Arch Gynecol Obstet 2021 May 11. Epub 2021 May 11.

Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.

Objective: To evaluate the safety in the first 12 h, efficacy and maternal satisfaction of a double balloon catheter (DBC) with vaginal prostaglandin (PGE) for induction of labour (IOL).

Methods: We conducted a multicentre randomised controlled study of 420 patients from 1st January 2016 to 31st December 2017 to evaluate the use of DBC in IOL in an Asian population looking at the adverse effects in the first 12 h after insertion. Women were assigned randomly to cervical ripening with either a DBC or a prostaglandin pessary. Read More

J Obstet Gynaecol 2020 Dec 2:1-5. Epub 2020 Dec 2.

Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.

A pre-post interventional study of patients undergoing office hysteroscopy alone and in combination with endometrial biopsy was performed during October 2015-March 2018 to evaluate the effect of low dose vaginal misoprostol on patient's pain. Pain scores were assessed using the visual analog scale at the completion of the procedure. There were 646 patients included in the study. Read More

J Obstet Gynaecol Res 2021 May 5. Epub 2021 May 5.

Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.

Aim: Whether the use of dinoprostone pessary increased the vaginal delivery rate of labor induction in Chinese nulliparous women with term premature rupture of membranes (PROM) and unfavorable cervices?

Methods: PROM women at term with singleton pregnancies and Bishop scores ≤4 who needed labor induction were enrolled in this retrospective study. They received either the dinoprostone pessary followed by oxytocin infusion if necessary (n = 102, PGE2 group) or oxytocin infusion alone (n = 103, oxytocin group).

Results: Compared with oxytocin infusion alone, vaginal delivery within 12 h and total vaginal delivery were higher in the PGE2 group (28. Read More

BMJ Open 2021 May 4;11(5):e050452. Epub 2021 May 4.

Edinburgh Clinical Trials Unit (ECTU) Usher Institute, University of Edinburgh, Edinburgh, UK.

Introduction: The aim of the cervical ripening at home or in-hospital-prospective cohort study and process evaluation (CHOICE) study is to compare home versus in-hospital cervical ripening to determine whether home cervical ripening is safe (for the primary outcome of neonatal unit (NNU) admission), acceptable to women and cost-effective from the perspective of both women and the National Health Service (NHS).

Methods And Analysis: We will perform a prospective multicentre observational cohort study with an internal pilot phase. We will obtain data from electronic health records from at least 14 maternity units offering only in-hospital cervical ripening and 12 offering dinoprostone home cervical ripening. Read More

Am J Perinatol 2021 May 2. Epub 2021 May 2.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah.

Objective:  Respiratory distress syndrome (RDS) is implicated in 30% of neonatal deaths. Since prostaglandins promote surfactant secretion and labor is associated with a lower risk of RDS in term neonates, it is plausible that synthetic prostaglandin (sPG) exposure is associated with a lower risk of RDS. Thus, we evaluated the association between sPG exposure and RDS in neonates born after the induction of labor (IOL). Read More

Int J Gynaecol Obstet 2021 Apr 30. Epub 2021 Apr 30.

Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Objective: To assess the effectiveness in preventing Caesarean section for failed induction by using Foley catheter for cervical ripening in comparison to Foley catheter with a weight attached to it.

Methods: Randomized control trial conducted between November 2018 and July 2020 which looked at induction of labor with 30 ml Foley catheter in one arm and the Foley placed with a 500 ml weight attached to it in the other arm. Primary outcome was the Caesarean section rate. Read More

Phytother Res 2021 Apr 29. Epub 2021 Apr 29.

School of Nursing, Hubei University of Medicine, Shiyan, China.

The evening primrose oil has prostaglandin effects and is applied to soften the cervix. This systematic review and meta-analysis aimed to establish the results of clinical trials performed on the effect of evening primrose oil on labor induction and cervical ripening in pregnant women. Research studies were searched from 1990 to September 2019 in Pubmed, Science Direct, Embase, and Cochrane Library using the keywords: cervical ripening, Bishop score, labor induction, post-term pregnancy, evening primrose, and any possible combination of these keywords (Farsi, English). Read More

Arch Gynecol Obstet 2021 Apr 27. Epub 2021 Apr 27.

Obstetrics and Gynecology Department, Centre Hospitalier Simone-Veil, Eaubonne, France.

Purpose: There are numerous methods for cervical ripening although not all of them are indicated in women presenting a higher risk of uterine hyperstimulation. To compare the efficacy and security of the two methods for cervical ripening in the induction of labor in these pregnancies.

Methods: Retrospective analysis of two cohorts consisting of pregnant women who gave birth from 2016 to 2019 (112 inductions with dinoprostone and 112 with intracervical double- balloon). Read More

BMC Pregnancy Childbirth 2021 Apr 19;21(1):310. Epub 2021 Apr 19.

Centre for Maternal and Child Health Sciences, School of Health Sciences, City, University of London, 1 Myddleton Street, London, EC1R 1UB, UK.

Background: Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK. Read More

Mol Cell Endocrinol 2021 Apr 3;529:111276. Epub 2021 Apr 3.

Division of Maternal-Fetal Medicine and Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA. Electronic address:

The cervix undergoes extensive remodeling throughout pregnancy and parturition. This process involves both ECM collagen degradation and cellular remodeling, which includes cell proliferation, transition and migration. Progesterone (P4) has been used clinically to delay cervical ripening and prevent preterm birth (PTB). Read More

Am J Obstet Gynecol 2021 Mar 23. Epub 2021 Mar 23.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.

Background: Induction of labor is common in the United States. Multiple previous studies have tried to outline a faster time to delivery to improve maternal and fetal outcomes.

Objective: This study aimed to evaluate whether women who undergo induction of labor with a single-balloon catheter and oxytocin have a shorter time to delivery with planned removal of the catheter at 6 vs 12 hours. Read More

Eur J Obstet Gynecol Reprod Biol 2021 May 15;260:124-130. Epub 2021 Mar 15.

Mater Research, The University of Queensland, Queensland, Australia; University of Queensland, School of Medicine, Queensland, Australia; Mater Mothers Hospitals, Queensland, Australia.

Objective: The aim of this work was to assess the cost-effectiveness of induction of labor with outpatient balloon catheter cervical priming versus inpatient prostaglandin vaginal gel or tape.

Study Design: Economic evaluation alongside a multi-centre, randomized controlled trial at eight Australian maternity hospitals. The trial reported on 448 women with live singleton term pregnancies, undergoing induction of labor for low-risk indications between September 2015 and October 2018. Read More

Acta Obstet Gynecol Scand 2021 Mar 25. Epub 2021 Mar 25.

Center of Perinatal Medicine and Health, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.

Introduction: Induction of labor is increasing. A common indication for induction of labor is late term and postterm pregnancy at 41 weeks or more. We aimed to evaluate if there are any differences regarding efficacy, safety, and women's childbirth experience between oral misoprostol and transvaginal balloon catheter for cervical ripening in women with a low-risk singleton pregnancy and induction of labor at 41 to 42 weeks of gestation. Read More

Pregnancy Hypertens 2021 Mar 3;24:79-89. Epub 2021 Mar 3.

Department of Anthropology, University of Delhi, Delhi, India. Electronic address:

Objective: Studies on One Carbon Metabolism (OCM), Interleukins-10 &-17 (IL-10/-17) & βhCG in pre-eclampsia and its delivery outcome (preterm birth) reveal contradictory results, attributed to clinical heterogeneity (early/late onset pre-eclampsia) or preterm/term birth. Disturbed OCM also influences IL-10 &-17 during pregnancy. We sought to investigate the synergism between OCM and IL-10/-17 mediated immune-regulation through βhCG in Early onset pre-eclampsia (EO-PE) patients, delivering preterm, among North Indian women. Read More

Biol Reprod 2021 Mar 24. Epub 2021 Mar 24.

Division of Maternal-Fetal Medicine and Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.

A physiologic increase in reactive oxygen species (ROS) throughout pregnancy is required to remodel the cervix. Oxidative stress (OS) can cause cellular damage that contributes to dysfunctional tissue. This study determined the effects of OS and the OS-induced cell fate of human cervical epithelial and cervical stromal cells. Read More

Am J Obstet Gynecol MFM 2021 Mar 20;3(4):100350. Epub 2021 Mar 20.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts-Baystate Medical Center, Springfield, MA (Drs Gagnon and Corlin, Mr St. Marie, and Dr Schoen); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA (Dr Berghella); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE (Drs Hoffman and Sciscione).

Background: The combination method for cervical ripening with a Foley catheter and concurrent oxytocin administration has been shown to reduce the total time from induction to delivery when compared with a Foley catheter only in patients with an unfavorable cervix (Bishop score of <6). It is unclear if this is still effective for patients with a less favorable cervix as indicated by a Bishop score of ≤3.

Objective: This study aimed to determine if inducing labor with a Foley catheter and concurrent oxytocin administration reduced the total time from induction to delivery in subjects with a Bishop score of ≤3 compared with those who only received a Foley catheter without oxytocin for cervical ripening. Read More

Obstet Gynecol 2021 Mar 22. Epub 2021 Mar 22.

Pacific Northwest Evidence-Based Practice Center, Medical Informatics and Clinical Epidemiology, the Department of Nurse-Midwifery, School of Nursing, the School of Public Health, Portland State University, and Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and Aggregate Analytics, Fircrest, Washington.

Objective: To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient compared with the inpatient setting, or different methods of ripening in the outpatient setting alone.

Data Sources: Searches for articles in English included MEDLINE, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.gov, and reference lists (up to August 2020). Read More

Ginekol Pol 2021 Mar 10. Epub 2021 Mar 10.

Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, Poland.

Objectives: The aims of the study is to analyze the effectiveness and safety of the use of intravaginal inserts with prostaglandin analogues: dinoprostone and misoprostol, in the labor induction.

Material And Methods: Pregnant women (177), with use of dinoprostone (n = 69) or misoprostol (n = 108) for labor induction were analyzed.

Results: The length of time of delivery differed significantly between primiparous and multiparous women and depended on the type of prostaglandin. Read More

Heliyon 2021 Mar 8;7(3):e06415. Epub 2021 Mar 8.

Debre Tabor University, College of Health Sciences, Department of Midwifery, Ethiopia.

Introduction: Failed induction increased maternal morbidity and mortality due to the associated complication which comes with cesarean section such as post partum hemorrhage and sepsis. The reports of previous articles on the proportion and associated factor of failed induction were variable and inconsistent. Therefore, this meta-analysis found out that the pooled proportion of failed induction and its associated factors in Ethiopia. Read More

J Matern Fetal Neonatal Med 2021 Mar 17:1-12. Epub 2021 Mar 17.

Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.

Objective: To define, illustrate and to follow-up the diagnosis, pathophysiology and treatment of a subset of the known enhanced myometrial vascularity (EMV): its extreme form, associated with cesarean scar pregnancies (CSP) and with some cases pf placenta accreta spectrum being at increased risk of significant bleeding complications. We also aim to provide guidance to the management of such cases.

Material And Methods: This is an IRB-approved retrospective observational study of thirteen patients with an extreme form of EMV complicating CSPs. Read More

Mol Cell Biochem 2021 Mar 15. Epub 2021 Mar 15.

Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, No.9, Jinsui Road, Tianhe District, Guangzhou, 510623, China.

Term labour is associated with activation of inflammation which results in myometrial contractility, cervical ripening and decidual/membrane rupture. Serum amyloid A1 (SAA1) is an acute response protein, whose role and underlying regulatory mechanisms in human labour remain unknown. In this study, we found that the mRNA and protein expression of SAA1 in human myometrium at term was increased in labouring tissues compared to non-labouring tissues. Read More

Obstet Gynecol 2021 04;137(4):662-663

Department of Obstetrics & Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, and the Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel.

Nurs Open 2021 Mar 10. Epub 2021 Mar 10.

Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Aim: To develop and validate the nomogram for risk estimation of Caesarean delivery and to compare the effect of cervical ripening balloon, evening primrose oil (EPO) and misoprostol on Bishop Score and duration of the first stage of labour.

Design: The first phase is a prospective study, and the second phase is a randomized controlled trial.

Methods: In the first phase, the nomogram will be developed and validated over 300 participants, and in the second phase, the 90 participants will be allocated to three groups: vaginal 25mcg misoprostol, vaginal 4000mg EPO and double-balloon catheter, through block randomization method. Read More

FASEB J 2021 Apr;35(4):e21463

Division of Maternal-Fetal Medicine and Perinatal Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.

Damage to the cervical epithelial layer due to infection and inflammation is associated with preterm birth. However, the individual and/or collective roles of cervical epithelial layers in maintaining cervical integrity remain unclear during infection/inflammation. To determine the intercellular interactions, we developed an organ-on-chip of the cervical epithelial layer (CE-OOC) composed of two co-culture chambers connected by microchannels, recapitulating the ectocervical and endocervical epithelial layers. Read More

Am J Obstet Gynecol MFM 2021 Feb 27;3(4):100343. Epub 2021 Feb 27.

Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.

Background: Pregnancies complicated by hypertensive disease of pregnancy often require labor induction. Rates of cesarean delivery range from 15% to 60% in this population. Nitric oxide deficiency has been shown to underlay the pathophysiology of preeclampsia, and nitric oxide promotes cervical ripening. Read More

Gynecol Obstet Fertil Senol 2021 Feb 23. Epub 2021 Feb 23.

Service de gynécologie-obstétrique, CHU de Saint-Pierre, Réunion, 410, 97, avenue du Président-Mitterrand, Saint-Pierre, Réunion.

Objective: To compare the effectiveness and the safety of cervical ripening between two methods: the Cook double balloon catheter and the dinoprostone pessary (Propess 10mg).

Methods: We performed a retrospective comparative study in a French maternity. We analyzed 404 women with induction of labour after 37 gestational weeks, with singleton cephalic live fetus, unscarred uterus, unruptured membranes, and Bishop score<6. Read More

J Matern Fetal Neonatal Med 2021 Feb 23:1-5. Epub 2021 Feb 23.

Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Labor induction is an important issue in modern obstetrics. One of the important factors for the success of induction of labor is the Bishop score of cervix.

Objective: The purpose of the present study was to evaluate and compare the efficacy of dilapan with extra-amniotic saline infusion and oral misoprostol for cervical ripening in term pregnancies. Read More