Abstract
To determine if adherence to an induction of labor (IOL) protocol decreases the rate of cesarean delivery (CD) for the indication of failed IOL (FIOL) compared to IOL practices based on provider preference, & to compare maternal & neonatal outcomes. Gravidas ≥ 24 weeks with a live, cephalic, singleton pregnancy with or without a prior CD undergoing indicated IOL with cervical dilation up to 2 cm & who received oxytocin in latent labor met inclusion criteria. A 1 year retrospective chart review was performed around implementation of a hospital IOL protocol. Protocol based (PB) inductions had amniotomy within 24 hours of starting oxytocin, intrauterine pressure catheter placement in latent labor with Montevideo units titrated to >200, & administration of oxytocin for at least 12 hours after amniotomy before diagnosing FIOL. Control for possible confounders was made by stratification (on parity) & by multivariate analysis adjusting for ruptured membranes & cervical ripening. A total of 366 women underwent PB IOL management & 230 non-protocol based (NPB). FIOL among all women was lower in the PB group (1.4%) vs. the NPB group (7.8%), p <.0001. PB management shortened the time to delivery by 4.7 hours (18.5 vs. 13.8 hours, p <.001). This trend remained after stratification on parity & multivariate analysis. Nulliparas in the PB group had a lower rate of FIOL vs. NPB group (3.8% vs. 9.8, p=.044). Multiparas in the PB group also had a lower rate of FIOL vs. NPB group (0 vs 6%, p=<.0003). PB management shortened the time to delivery by 5.2 hours in nulliparas (22.6 vs. 17.4 hours, p= .0002) & 2.7 hours in multiparas (14.5 vs. 11.8 hours, p<.0001). There were no differences in infectious morbidity or neonatal outcomes between the two groups. By following a protocol for IOL that standardizes intrapartum management of latent labor & the definition of FIOL, the rate of FIOL & time to delivery was decreased in both nulliparas and multiparas.Tabled 1Multivariable analysis of outcomes among all patients undergoing induction of labor, stratified by parityData are mean ± SD or n (%) unless otherwise specified; p values are adjusted for rupture of membranes & cervical ripening. Open table in a new tab
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