Labor Induction Methods: Compared Outcomes Jenifer E. Smith, SN, CLD Cedar Crest College, Allentown, PA

EDUCATOR. ADVOCATE. FRIEND. What is a Doula? EDUCATOR. ADVOCATE. FRIEND. A Doula provides: Evidence-based Information Emotional Support Physical Comfort

Objectives Describe significance of research to determine best evidence-based practice for labor induction methods. State one aspect of the research data retrieval process and analysis. Describe one recommendation to improve future processes.

PICO Question: P: Patient Population Term to late-term nulliparous or multiparous pregnant women I: Intervention Transcervical Foley catheter induction C: Comparison Pharmacological, prostaglandin induction O: Outcome The number of vaginal deliveries?

PICO Question: In term to late-term pregnant nulliparous or multiparous women does transcervical catheter induction compared to pharmacological induction reduce the number of vaginal deliveries?

Significance Induction rates in the US have more than doubled since 1990 – 1 in 4 births will be induced (AWHONN, 2014). Induction and labor augmentation of labor are 1 of the top 3 perinatal liabilities with patient risk (Simpson & Knox, 2005). Induction has a high risk of leading to a cesarean surgery, which has its own risks (AWHONN, 2014).

Cesarean Risks Infection Abnormal placenta attachment in future pregnancies Fetal stress Respiratory illness Interrupted bonding and breastfeeding (AWHONN, 2014)

“Code of Ethics for Nurses” Provision 3 "The nurse promotes, advocates for, and protects the rights, health, and safety of the patient." Provision 3.4 "Professional Responsibility in Promoting a Culture of Safety." Provision 3.5 "Protection of Patient Health and Safety by Acting on Questionable Practice." Provision 7 "The nurse, in all roles and settings, advances the profession through research and scholarly inquiry..." (ANA, 2015)

Literature Search Methods Databases: PubMed and WorldCat Keywords: Foley labor induction, catheter labor induction, prostaglandin labor induction, cervical ripening, and catheter, prostaglandin, induction Inclusion criteria: peer-reviewed, published within 2010 - 2015, human trials Exclusion criteria: induction subgroups of specific targets, early induction, simultaneous induction methods

Research Overview Level II/Good Quality: Cromi et al. (2012) Randomized controlled trial – double-balloon transcervical catheter to prostaglandin vaginal insert Small sample, 210 women Vaginal delivery occurrence higher in the transcervical catheter group Secondary Finding: Uterine hyperstimulation occurrence higher in the prostaglandin group

Research Overview Level I/High Quality: Jozwiak et al. (2012) Randomized controlled trial – transcervical catheter to prostaglandin vaginal insert Small sample, 226 women & meta-analysis of top rated quality comparable randomized controlled trials Comparable vaginal and cesarean deliveries in both groups Secondary Finding: Uterine hyperstimulation occurrence higher in the prostaglandin group

Research Overview Level I/Good Quality: Vaknin, Kurzweil, & Sherman (2010) Meta-analysis of 27 Randomized controlled trials – transcervical catheter to prostaglandin vaginal insert in term pregnancies 3,532 participants combined through all trials reviewed Comparable vaginal and cesarean deliveries in both groups Secondary Finding: Uterine hyperstimulation and abnormal contraction patterns occurred higher in the prostaglandin groups

Research Conclusions Evidence found a patient safety concern! Uterine hyperstimulation occurrence was higher in prostaglandin groups in all research reviewed Uterine Hyperstimulation Risks: Late fetal heart decelerations or fetal tachycardia Fetal stress leading to meconium aspiration risk

Research Recommendations More Randomized Controlled Trials Larger sample sizes with specific criteria: type of prostaglandin, size of catheter, balloon volumes, maximal period of cervical ripening time Qualitative Research Part of evidence-based practice considers patient preference Encouragement to utilize Foley catheter induction Given the uterine hyperstimulation risk found with prostaglandin use, Foley catheter method should be utilized more often

References American Nurses Association [ANA]. (2015). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/DocumentVault/Ethics_1/Code-of-Ethics-for-Nurses.html ANA new logo. (2016). Retrieved from http://www.nursingworld.org/DocumentVault/Ethics_1/Code-of-Ethics-for-Nurses.html Association of Women's Health, Obstetric and Neonatal Nurses [AWHONN]. (2014). Position statement discourages induction of labor without medical indications. Nursing for Women's Health, 18(6), 535-537. doi:10.1111.1751-486X.12168 Cesarean Birth 2. (2010). Retrieved from http://homebirthaustralia.org/10/07/2010/infant-and-neonatal-mortality-for-primary-cesarean-and-vaginal-births-to-women- with-no-indicated-risk Cook Cervical Ripening Balloon. Retrieved from http://gynecology.blogsky.com/category/cat-7/ Cromi, A., Ghezzi, F., Uccella, S., Agosti, M., Serati, M., Marchitelli, G., & Bolis, P. (2012). A randomized trial of preinduction cervical ripening: Dinoprostone vaginal insert versus double-balloon catheter. American Journal of Obstetrics & Gynecology, 207(2), 125.e1-125.e7. doi:10.1016/j.ajog.2012.05.020 Jozwiak, M., Rengerink, K. O., Eikelder, M. L., Pampus, M. G., Dijksterhuis, M. G., Graaf, I. M., … Bloemenkamp, K. W. (2013). Foley catheter or prostaglandin E2 inserts for induction of labour at term: An open-label randomized controlled trial (PROBAAT-P trial) and systematic review of literature. European Journal of Obstetrics & Gynecology and Reproductive Biology, 170, 137-145. doi:10.1016/j.ejogrb.2013.06.017 Simpson, K. R., & Knox, G. E. (2005). Essential criteria to promote safe care during labor and birth. AWHONN Lifelines, 9(6), 478-483. doi:10.1177/1091592305285270 Tachycardia. (2014). Retreived from http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_heart_monitoring.htm Vaknin, Z., Kurzweil, Y., & Sherman, D. (2010). Foley catheter balloon vs locally applied prostaglandins for cervical ripening and labor induction: A systematic review and metaanalysis. American Journal of Obstetrics & Gynecology, 203(5), 418-429. doi:10.1016/j.ajog.2010.04.038 Walling, A. D. (2002). Uterine hyperstimulation depends on misoprostol route. American Family Physician, 65(2), 279-280.

Questions. You can direct all questions and discussion to: Jenifer E Questions? You can direct all questions and discussion to: Jenifer E. Smith jesmith@cedarcrest.edu