Jessica Rhinehart-Ventura1, Catherine Eppes1, Haleh Sangi-Haghpeykar1, Christina Davidson2. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX. 2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX. Electronic address: cmdavids@bcm.edu.
Abstract
OBJECTIVE: The purpose of this study was to determine whether adherence to an induction of labor (IOL) protocol decreases the rate of failed IOL (FIOL). STUDY DESIGN: We performed a 1-year retrospective chart review around the implementation of a hospital IOL protocol and compared maternal and neonatal outcomes from deliveries managed per protocol (n = 369) with those deliveries that were not (n = 230). Women at least 24 weeks' gestation with cervical dilation up to 2 cm who underwent an indicated IOL were included. Protocol-adherent (PA) inductions had amniotomy within 24 hours of starting oxytocin, intrauterine pressure catheter placement in latent labor, Montevideo units titrated to 200-300 or to adequate cervical change, and oxytocin administered for at least 12 hours after amniotomy before FIOL was diagnosed (defined as delivery by cesarean during latent labor as a result of failure to enter active labor). The primary outcome was the rate of FIOL. Control for possible confounders was made by stratification and multivariate modeling. RESULTS: FIOL rates were lowest in the PA group, which remained significant after stratification on parity and multivariate analysis (nulliparous women, 3.8% vs 9.8%; P = .043; multiparous women, 0% vs 6%; P < .0004). Median time to delivery was shortest in the PA group by 3.5 hours in nulliparous women (16.0 vs 19.5 hours, respectively; P = .0002) and 1.5 hours in multiparous women (10.75 vs 12.25 hours, respectively; P < .0001). There were no differences in infectious morbidity or neonatal outcomes between the groups. CONCLUSION: Adherence to a standardized IOL protocol is associated with a decreased rate of FIOL and length of labor.
OBJECTIVE: The purpose of this study was to determine whether adherence to an induction of labor (IOL) protocol decreases the rate of failed IOL (FIOL). STUDY DESIGN: We performed a 1-year retrospective chart review around the implementation of a hospital IOL protocol and compared maternal and neonatal outcomes from deliveries managed per protocol (n = 369) with those deliveries that were not (n = 230). Women at least 24 weeks' gestation with cervical dilation up to 2 cm who underwent an indicated IOL were included. Protocol-adherent (PA) inductions had amniotomy within 24 hours of starting oxytocin, intrauterine pressure catheter placement in latent labor, Montevideo units titrated to 200-300 or to adequate cervical change, and oxytocin administered for at least 12 hours after amniotomy before FIOL was diagnosed (defined as delivery by cesarean during latent labor as a result of failure to enter active labor). The primary outcome was the rate of FIOL. Control for possible confounders was made by stratification and multivariate modeling. RESULTS: FIOL rates were lowest in the PA group, which remained significant after stratification on parity and multivariate analysis (nulliparous women, 3.8% vs 9.8%; P = .043; multiparous women, 0% vs 6%; P < .0004). Median time to delivery was shortest in the PA group by 3.5 hours in nulliparous women (16.0 vs 19.5 hours, respectively; P = .0002) and 1.5 hours in multiparous women (10.75 vs 12.25 hours, respectively; P < .0001). There were no differences in infectious morbidity or neonatal outcomes between the groups. CONCLUSION: Adherence to a standardized IOL protocol is associated with a decreased rate of FIOL and length of labor.
Authors: William A Grobman; Jennifer Bailit; Yinglei Lai; Uma M Reddy; Ronald J Wapner; Michael W Varner; John M Thorp; Kenneth J Leveno; Steve N Caritis; Mona Prasad; Alan T N Tita; George Saade; Yoram Sorokin; Dwight J Rouse; Sean C Blackwell; Jorge E Tolosa Journal: Am J Obstet Gynecol Date: 2017-11-11 Impact factor: 8.661