Paraception based on evidence -based evidence: induction of labor

Contraindications, indications and childbirth time

Table 1 lists taboos for induction of labor.Table 2 and Figure 1 list the selection indicators of obstetrics, medicine or fetuses and induction of labor.Generally speaking, no presented induction of labor should not be performed before 39 weeks of pregnancy.

In the maximum RCT and RCT agents analysis, the 390-396 weeks of low-risk pregnancy with a single, head, or no other induction of labor is induced. Compared with the expectation of about 40+5 weeks, it can significantly reduce hypertension during pregnancy.The onset of disease, cesarean section, amniotic fluid dung, and newborn respiratory system.In the Arrive trial, the standard for quoting the birth at 39 weeks of pregnancy is as follows: (1) determine the last menstrual time, and the date is consistent with the results of the ultrasound test before 200 weeks, or if the last menstrual period is uncertain, the ultrasound test results before 140 weeks are available;2) No taboos of vaginal delivery; (3) 40+5 weeks before there are no other disease indications that need to be given childbirth (such as, limited growth of hypertension or suspicious fetus).In addition, this strategy can reduce the risk of dead tires.In general, compared with expectations, the above -mentioned situation of induction of labor can be reduced by 12%of the risk of cesarean section, 50%of the risk of death, and the risk of admission of newborn intensive care unit (NICU) is reduced by 14%, 31085).Therefore, staff should discuss with pregnant women with low -risk "39 weeks of pregnancy" options for induction of labor, because this will bring benefits to maternal fetuses/newborns without related damage.

In short, there are many indications for induction of labor, including obstetrics, maternal and fetal indications, and other medical indicators.Compared with expectations of management, the risk of cesarean section, death and neonatal admission can be significantly reduced.Democracy at 39 weeks of pregnancy can reduce hypertension diseases, cesarean section, dead tires, amniotic fluid dung, and neonatal respiratory diseases (strong recommendations) during pregnancy.

Forecast of vaginal delivery

The probability of primary maternal and maternal cervical cervical length <20mm in vaginal delivery within 24 hours of vaginal delivery was 80%and 90%, respectively.The Bishop score is 96%of the vaginal delivery after 9 points, but <6 6 points for predicting the sensitivity of cesarean section are poor.Although the risk calculator can be used to predict the cesarean section after labor, it may only be applicable to specific groups (national or local), and the benefits of individuals may be limited.

In short, there is no sensitive or special prediction method to determine the incidence of cesarean section after labor (weak recommendation).

Optional method for cervical maturity and induction of labor

Foley catheter

In terms of uterine excessive stimulation and NICU admission, the Foley ball pocket catheter has the best safety and does not increase the risk of intact infection of the fetal membrane (26 studies, 5563).Compared with the 30ml balloon, 60-80ml can appropriately shorten the output (gathered analysis: 7 RCTs, 1432).Double -ball pipes (such as COOK catheter) do not reduce childbirth time, or cesarean section rates (section analysis: 5 studies, 996).Compared with the single -ball pocket guideline (Members analysis: 2 studies, 405), the use of double -ball pockets will increase pain.Due to the high cost and effectiveness of validity, it is recommended to use single -ball pockets (figurine analysis: 4 studies, 796).In one RCT, by fixing the catheter on the patient’s thigh pulling the catheter, the duct can be shortened to the discharge time, but compared with the traction, it does not shorten the time interval from insertion from the catheter to childbirth.The other two RCT found that the 500-1000ml water bottle pull pipe has the same effect above.It is not recommended to be fully researched through the pipe’s water injection from the amniotic space. It is not recommended.After 12 hours, remove the Foley catheter and start the oxytocin induction at the same time. Compared with waiting for Foley catheter, it can shorten the childbirth interval compared to the 24 -hour.

Machalmolitol

Compared with vaginal meol, oral meol alcohol, and vertical ketone sustained release, the gradually increased low-dose oral meter solution (for example, start 25ug, then 25Ug every 2-4 hours or 4 hours 50Ug) The risk of cesarean section or 24 -hour vaginal delivery is the lowest, and the uterine excessive stimulation is rare (the analysis: 611 RCT, N ≥100000).Large -dose vaginal or oral administration (> 50 UG) will not significantly reduce the rate of cesarean section or the failure rate of childbirth within 24 hours, and increase the incidence of excessive uterine stimulation, so it should be avoided.The taboos of maco anterior glycol include more than 3 times in the uterine contraction in 10min or the history of previous uterine scars.

Dino anteriorone

Compared with the Foley catheter or maco anterior alcohol, considering the increase in cost, excessive stimulation of the uterus, and the failure rate of childbirth within 24 hours, when the Foley or macoolitoneol is available, the prefarm ketone cache embolism or other prostaglandin E2 does not notApply to mature or induced labor.

Meterone

RCT does not have sufficient data to support meterone for induction of labor (1018).

Combination method

Compared with the FOLEY catheter, FOLEY+Miso can reduce the induction of labor to childbirth and excessive stimulation of uterine, but it cannot reduce the risk of cesarean section (15 studies: 15 studies, more than 2470).Compared with FOLEY, FOLEY+oxytocin can also reduce childbirth time, and can not reduce the risk of cesarean section (in charge analysis: 6 studies, 1133).Compared with the use of oxytocin, Puylol’s joint oxytocin can shorten the incubation period and the total childbirth duration, but more high -quality research data support (6 RCT, 609).Due to the continuous oxytocin infusion increased the burden of nursing, Foley combined with Miso (except Miso taboos) is currently the best way to promote cervical maturity in pregnant women in hospitalization.

Stripping film

Increased production can increase the chance of vaginal delivery, especially the effect of first maternal maternal (fancy analysis: 4 RCTs, 1377).

Artificial film

After the cervix matures, the conventional early film breaking can reduce the induction of labor to about 5 hours.It does not increase the opportunity of cesarean section (a collection of analysis: 4 RCTs, 1273).

Other methods

In general, RCT research data for other induction methods is not enough to evaluate its safety and effectiveness, such as acupuncture, breast irritation, cymbal oil, enema and bathing, trending therapy or sexual intercourse.

In short, it is recommended to use a 60-80ml single-ball bag Foley catheter for 12 hours; or start taking 25ug of Miso, then take 25ug every 2 hours, or take 50Ug every 4 hours (not more than 3 times per 10min contractions, or used to the pastThere is no history of uterine surgery);Considering additional stripping (weak recommendation) should also be considered.After 12 hours of departure or left for the catheter, artificially broken membranes (weak recommendation) should be considered (Figure 2).

The management of oxytocin after active period

For the lady with sufficient contractions after the active period is interrupted and infused with oxytocin (cervical expansion 5-6cm), compared with continuing to lose to childbirth, it can reduce the risk of cesarean section by 35%, and 50%of the contraction is too strong.Essence(Meeting analysis: 9 studies, 1538).Stopping the use of oxytocin after active period can extend the active period by 30 minutes and extend the second outbuilding process, which may affect the ending of the newborn (such as acid ledmia) and the maternal ending (such as infection and postpartum bleeding).For this aspect, the evaluation ability of the charm may be insufficient.In addition, on average, after oxytocin interruption, 30%of the custody of the process needs to be restarted due to the stagnation or extension of the output.

In short, once the cervix expands to 5 cm during the induction of labor, if you are using oxytocin and have sufficient contractions, you can consider discontinue oxytocin (weak recommendation).

Termprelabor Rutture of Membranes induction

Compared with expectations of management, if the rupture of the fetal membrane in the full month is not leaning, it is recommended to use oxytocin induction.In the induction group, most RCT started induction of labor within 12 hours after the rupture of the membrane (COCHRANE: 23 RCTs, 8615).In such cases, the Foley catheter does not shorten the childbirth time on the basis of oxytocin induction. On the contrary, it may increase the risk of infection (2 RCTs, 329).Compared with oxytocin induction, oral oxytocin has no advantage (RCT, 305).In terms of ending, there is no significant difference in the FOLEY catheter compared to Miso anterior glycol (1 RCT, 209).

In short, if there is no labor, it is recommended to use the rupture of the full moon membrane (as soon as possible) to induces labor (strongly recommended) within 12 hours.

Outpatient cervical maturity

Due to excessive irritation, stimulating amniotic fluid dung, and insufficient security data, it is not recommended to use maco anterior alcohol and groundo anterior ketone to promote cervical maturity (2 RCTs, 928).On the contrary, using the Foley catheter alone is safe. Under the conditions of hospitalization, the incidence of adverse events is only 0.0%-0.26%, mainly "pain discomfort" (charges analysis: 26 studies, 8292).Compared with the hospitalization FOLEY, the outpatient clinic is shorter (RCT, 130), which can reduce costs, although this may not be suitable for maternal women (RCT, 129).The outpatient clinic uses FOLEY to reduce the tendency of cesarean section.The outpatient FOLEY women are more satisfied with hospitalization.Outpatient patients using the Foley catheter should have reliable transportation and approach the hospital appropriately.The management process of FOLEY in the outpatient patient’s cervix is shown in Figure 3.

In short, the outpatient Foley catheter induction of labor is safe and effective, so it can be provided to patients (weak recommendations).

During childbirth time and induction of labor failure

The output of labor is generally slightly longer than the natural production, but for primary women, the average production process such as FOLEY+Miso or oxytocin is about 16-17 hours, and the average maternal average is about 9-10 hours.A cesarean section should not be produced (without other indications) about 15 hours after injection of oxytocin or artificial membrane. If feasible, it is best to consider cesarean section after 18-24 hours of oxytocin.(Weak recommendation).

Table 1 Taboo for induction of labor

abnormal situation

General Clicporant Pregnancy Week (WKD)

Obstetrics

Fetal horizontal or slope (first exposed abnormalities)

390-396

More than 2 times in the past and lower segments of cross -section cesarean section

380-396

Front placenta

360-376

Placental plantation

340-356

Prefix blood vessel

340-366

Maternal condition

Past classical cesarean section

360-376

Earlier uterine fibroid resection requires cesarean section

370-376

The history of the uterine rupture

360-376

Active reproductive herpes infection

390-396

HIV virus load> 1000 copies/ml

380-386

Fetal condition

Abnormal fetal monitoring may affect the birth of fetal fetus tolerance

During diagnosis (for individualization of siege daily periods)

Umbilical cord

Diagnosis

other

Any other vaginal delivery contraindications

Rely on diagnosis

Table 2 Induction indications for delivery timing under specific circumstances

state

Pentament of gestational weeks (WKD)

Quality of evidence

Recommended strength

Obstetrics

Internal infection (such as cashmere inflammation)

Discovery

middle

powerful

Early peel

Discovery

middle

powerful

39 weeks

390-396

high

powerful

Maternal condition

Chronic Hypertension-Unexical Medicine

380-396

high

powerful

Chronic hypertension-drug control

370-396

high

powerful

Chronic hypertension-difficult to control (need to adjust the drug frequently)

360-376

middle

weak

Hypertension during pregnancy

370-376 or after diagnosis

high

powerful

Earlampst epilepsy-there is no serious clinical manifestation

370-376 or after diagnosis

high

powerful

Earlamps early-serious clinical manifestations

340 or after diagnosis

high

powerful

Liga

Discovery

middle

powerful

PGDM-good control

390-396

middle

powerful

PGDM-Poor control

340-386

Low

weak

GDM-good diet control

390-396

middle

powerful

GDM-Drug control is good

390-396

middle

powerful

GDM-Poor Drug Control

340-396

Low

weak

ICP, bile acid ≥100

360-376

Low

weak

ICP, bile acid <100

370-396

Low

weak

History of death

390-396

Low

weak

Prom

340-366

high

powerful

Fetal condition

IUGR-single tire, no other comorbidity, normal umbilical blood flow

380-396

middle

weak

IUGR-single tire, umbilical bloodstream diastolic blood flow decreases but exists

370-376

middle

weak

IUGR-single tire, umbilical bloodstream diastolic blood flow lack of blood flow

340-346

middle

weak

IUGR-single tire, umbilical bloodstream diastolic blood flow reverse

320-326

middle

weak

IUGR-twin, DCDA, isolated IUGR, umbilical blood flow is normal

360-366

Low

weak

IUGR-twins, MCDA, isolated IUGR, umbilical blood flow is normal

320-346

Low

weak

Giant (EFW> 4000g or LGA> 95 %)

380-386

high

weak

Tire: DCDA, non -complications

370-376

middle

weak

Tire: MCDA, non -complications

360-366

Low

weak

Tire: MCMA, non -complications

320-346

Low

weak

Too few amniotic fluid (MVP <2cm) -O isolation

370-376

Low

weak

Abnormal fetal heart monitoring (such as three types of monitoring)

Discovery

Low

powerful

Fetal death

Discovery

Low

weak

Fig

Figure 2 Cervical expansion <Recommended by 3cm Recommended production method *10min> 3 contractions or history of uterine scars.** Use maco or oxytocin to monitor the fetal heart continuously

Figure 3 Outpatient balloon pockets to promote the mature cervical process

Table 3 Recommendation of evidence -based induction of labor intervention

Intervention

recommend

Quality of evidence

Recommended strength

Obstetrics, maternal and fetal indications induction of labor

See Table 2

high

powerful

39 weeks induction of labor

It can induce labor at 39 weeks

high

powerful

predict

There is no sensitive or special prediction method to determine the incidence of cesarean section after labor

Low

weak

Preparation of labor

It is recommended to use 60-80ml Foley single-sac catheter for induction, last 12h, orally 25ug at the prefrontalol, and then take 25UG every 2-4 hours, or take 50Ug every 4-6h (if there is no history of uterine surgery or every 10min contractions every 10min contractionNo more than 3 times), or the oxytocin is induced.

high

powerful

Stripping film

You can consider peeling the membrane before the introduction of labor

middle

weak

Artificial film

When the foley ureter is discharged or placed for 12 hours, you can consider artificially breaking the film

middle

weak

Enter the use of active oxytocin

Cervical expansion of cervix 5-6cm after induction of labor. If you keep using oxytocin and contracted well, you can consider interrupt oxytocin

Low

weak

PROM’s induction labor

If the full moon PROM is not available, it should (such as feasibility) or the diaphragm does not exceed 12 hours.

high

powerful

Outpatient labor

The outpatient clinic can provide FOLEY catheter to promote cervical maturity

high

powerful

Failure for labor cesarean section

Do not cesters the section within 15 hours after a quiet oxytocin or artificial membrane. In possible circumstances, it is best to have no giving birth after the injection of oxytocin for 18-24 hours.

Low

weak

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